Certification Scholarship Application

ASSISTANCE LEAGUE OF MONTGOMERY COUNTY
General Information
Current Date*
MM slash DD slash YYYY
Name*
First Middle Last
Marital Status (Check appropriate box.)*
- Married
- Single
- Divorced
- Widowed
- Other
Other Name you may have used. (If you have not used another name, type "None".)*
First Maiden Name Last
Birth Date*
MM slash DD slash YYYY
Last four digits of your Social Security Number*
List name of spouse, if married.*
First Last
Cell Phone*
Email*
Are you a resident of Montgomery County?*
- Yes
- No
Are you a U.S. Citizen?*
- Yes
- No
If a naturalized citizen, what year did you receive your citizenship?*
Address (Please do not use Post Office Box (PO Box) number.*
Street (Mailing) Address Address Line 2 City State / Province / Region ZIP / Postal Code
How long have you lived at this address?*
School Information
Did you graduate from high school?*
- Yes
- No
High School Information*
Name of High School you attended Location of High School Year Graduated from High School
If you did not graduate, did you earn your GED?*
- Yes
- No
For what certification Program of Study are you applying?*
At what Lone Star location are you applying? (Check appropriate box.)*
- Conroe
- Cy Fair
- Kingwood
- Montgomery
- North Harris County
- Tomball
- Other
What is the total cost of this Program?*
When does the program begin?*
When will this program end?*
Student ID No.*
What is the FIRST COURSE you will be taking?*
Name of your Lone Star College Advisor*
Financial Information
Complete the Free Application for Federal Student Aid (FAFSA) Form, located at fafsa.ed.gov. Upon successful completion of the form, you will receive the Student Aid Index (SAI) form that contains information about student aid for which you are eligible. The SAI is reported on your FAFSA report.
What is your Student Aid Index (SAI) number*
Approximate Annual Reported Gross Family Income*
Do your parents consider you a dependent for tax purposes?*
- Yes
- No
Source of Annual Gross Family Income - (for example, salary, child support, government assistance, SSI, SSDI, etc.)*
Other Sources of Annual Gross Family Income*
Are you the Head of Household? NOTE: You can claim Head of Household if you are unmarried, having cared for a dependent for over half a year, and paid more than half the cost of maintaining a home.*
- Yes
- No
Dependents (Persons for whom you provide at least 50% of their financial support)
Name Age Relationship to Applicant
Name Age Relationship to Applicant
Name Age Relationship to Applicant
Name Age Relationship to Applicant
Employment
Are you presently employed? If Yes, please answer the first three questions below.*
- Yes
- No
1) Who is your employer?
2) Type of Work or Position
3) How many hours per week?
If not employed, list reasons for your unemployment.
Previous work experience. (If none, type "None".)*
ESSAY - In your own words: 1) Explain in detail why you are pursuing this certification, and 2) Tell us your future plans.*
E-Signature
By submitting this application and checking the certification box below, I certify that the information included in this application is true and correct to the best of my knowledge. I authorize release of information to confirm and/or verify the contents for scholarship purposes only. In addition, I give Assistance League of Montgomery County permission to publish in print, electronic, or visual format the likeness or image of me. I waive any rights of compensation or copyright ownership thereto.
Certification:*
- I certify the information as stated above.
Submission Instructions
Submit your application. After your advisor fills out your Planned Proram of Study, email that form to almc.scholarship@gmail.com. After your application is reviewed, you will be contacted to schedule an interview date. At the interview, you will need to bring your Student Aid Index (SAI) from your FAFSA and a picture ID (preferably your drivers's license). NOTE: You will not be considered for this scholarship until Assistance League has received your application and your Planned Program of Study.
Questions
Should you have any questions, please send an email to the Scholarship Team Leader at almc.scholarship@gmail.com.
Captcha

Name of High School you attended	Location of High School	Year Graduated from High School

Name	Age	Relationship to Applicant

Name	Age	Relationship to Applicant

Name	Age	Relationship to Applicant

Certification Scholarship Application

Certification Scholarship Application

ASSISTANCE LEAGUE OF MONTGOMERY COUNTY

General Information

School Information

Financial Information

Dependents (Persons for whom you provide at least 50% of their financial support)

Employment

E-Signature

Submission Instructions

Questions