Scholarship Application

* Required Field

Personal Information

Applicant Type:

First Name*
Middle Initial
Last Name*
 
Birth Date*
 
Address* (Street No Apt.)
City*
 
State*
Zip Code*
Primary Phone No.*

Alternate Phone No.
Email*

Application for Semester (check one or both)
How did you hear about TNS scholarship?  

Employment

Does your employer assist with tuition costs?
Current Employer*
Supervisor
Address
Phone*
 
Dates of Employment
Hours Per Week
Previous Employer
Supervisor
Address
Phone
Dates of Employment
Hours Per Week

Recovery Program

Which 12-Step recovery program do you attend?



12-Step Sponsor
Phone
Your Home Group
Dry Date
Years in 12-Step Program
Years in other program(s). Describe:
Service/volunteer work. Describe:
Are you willing to volunteer to work on a The Next Step fundraising project?

Finances

Discuss past debts, which you have or for which you are making restitution. Include the total amount of your outstanding debt(s).


Income & Expenses:

List monthly income and expenses from the following sources:
Monthly Income
Employment $ Allowance $
Child Support $ Family Support $
Alimony $ Trusts $
Investments $ Other/Explain: $ /
Total Income
Monthly Expenses
Car Payment $ Fuel $
Legal Expenses $ Family Restitution $
Cell Phone $ Entertainment $
Summer School $ $
Rent/Mortgage $ Utilities $
Phone Bill $ Car Insurance $
Health Insurance $ Rent/House Insurance $
Credit Card Payments $ Child Support $
Alimony $ Loan Payments $
Tuition $ Debts/Restitution $
Food $ Other/Explain: $ /
Total Expenses
List Any Other Educational Resources You Receive: Please provide the amount and an explanation below:
Scholarships
Grants
Tuition Reimbursement or Loans

Education

Check the ones that apply:
Last grade completed
Check your progress:
Transfer hours   Degree Hours 
BS/BA hours   Master’s hours    PhD hours 
Courses completed
Courses completed
Training Received

Enrollment

Are you currently enrolled?
Where?
Which Semester?
Credit Hours Currently Enrolled in This Semester
When do you expect to graduate?
What is your field of study?
How many hours will you be taking in the upcoming semester?
What is the cost per credit hour?
Have you ever enrolled at this level of education before? Explain below:
Grades from your last semester in school (list courses and grades):

Financial Assistance Request

$
$
$
$
$
Explain:

Short Essay

Type a short essay that explains your plans and why you feel you are a good candidate for this program. Include your name and birth date at the top of your essay. Include answers to the following questions with your essay.
  1. What is your academic or vocational goal?
  2. How will achieving this goal change your life or the life of others?
  3. Why should The Next Step help you reach this goal?

READ THE FOLLOWING. SIGN TO ACKNOWLEDGE YOUR UNDERSTANDING OF THE REQUIREMENTS.
I have read and understand the Requirements and Deadlines, and understand that, if I am awarded, I will be ineligible to receive my funds if these guidelines are not followed. I certify that all of the information given to The Next Step is true and accurate. I understand that the decisions regarding my application are based upon the information that I have provided. I authorize The Next Step to examine, verify and discuss my employment, recovery program, academic and/or financial records and other information that applies to me in connection with this application. Also, I agree to keep the Board up to date on pertinent issues and changes related to my recovery and education.
Signature*   Date*  

Should I be awarded a scholarship, I grant The Next Step permission to utilize my likeness in any photographs or videos without fee or any claims relating to said photographs or videos.