Test FORM "*" indicates required fields Step 1 of 9 0% APPLICANT INFORMATIONApplication Date* Month Day Year Application Type* Former or current recipient First time applicant How did you learn about The Next Step scholarship?*If you were referred by a current or former scholarship recipient, please list their name. Application for Semester (check all that apply)* Summer 2023 Fall 2023 Spring 2024 CONTACT INFORMATIONLegal Name* First Last Preferred Name (if different) First Last Address* Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Phone Number*Email* DEMOGRAPHICSThis information is gathered for statistical and grant purposes. The Next Step does not discriminate on the basis of any of these questions.Date of Birth* Month Day Year Current Marital Status*Single, never marriedMarriedDomestic PartnershipWidowedDivorcedSeparatedTo which gender do you identify?*MaleFemaleTransgenderOtherPrefer not to answerWhat is your ethnicity? Select all that apply.*American Indian or Alaskan NativeAsian or Pacific IslanderBlack or African AmericanHispanic or LatinoWhite/CaucasianPrefer not to answerOtherAre you a single parent?*A single parent is defined in this instance as an individual who is the primary caretaker of a child(ren) under the age of 18 living in their home at least 50% of the time and who does not have a spouse or partner. Yes No Prefer not to answer If applicable, how many children under the age of 18 are currently living in your home? RECOVERY PROGRAMWhich 12-step recovery program(s) do you attend?*You must be active in a 12-step recovery program to apply for this scholarship. Alcoholics Anonymous (AA) Narcotics Anonymous (NA) Heroin Anonymous (HA) Cocaine Anonymous (CA) List your participation in any other recovery related programs. What is your recovery date? You must have 1 year (12 consecutive months) by the application deadline of April 1.* Month Day Year Number of Years in a 12-Step Program 12-Step Sponsor Name Sponsor Email Sponsor Phone NumberSponsor Recommendation LetterYou CAN submit your application without your sponsor letter. If you have the letter, please upload it here. If you do not have your letter yet, please submit your application and your sponsor can mail or email it to us by April 1.Max. file size: 20 MB.What is the name of your home group? Describe years in other program(s):Please describe any service or volunteer work you are doing: EMPLOYMENTWhat is your current employment status?*Please note that employment is a requirement to qualify for the scholarship.Full-time employmentPart-time employmentOtherIf you selected other, please explain your current employment situation.*Does your employer assist with tuition costs? Yes No Current Employer* Proof of EmploymentPlease upload a recent paycheck stub, hire letter, or other documentation to show proof of employment. We will not contact your employer without permission. You can submit your application without this document, but you will need to provide it to us by April 1.Max. file size: 20 MB.Job Title/Position Supervisor Name Dates of Employment Hours per Week Previous EmployersPlease provide at least one previous employer. Use the + sign to add additional employersEmployer NameDates of EmploymentHours per Week Add Remove FINANCESFinancial History*Discuss your past debts, which you have or for which you are making restitution. Include the total amount of your outstanding debt(s).As of today, what is your (and partner's) total current balance of cash, savings, and checking accounts?* As of today, what is the net worth of your (and partner's) total current investments?*Examples are retirement accounts, investment accounts, trust funds, and real estate (other than the home you live in). Do you owe any back tuition to an educational institution?*This situation would be any instance where you would not be allowed to enroll because of an outstanding balance. It DOES NOT include student loans. Yes No Please explain how much you owe and the circumstances. Housing and Living SituationWhat is your current living situation?*OwnRentSober Living HouseLive with ParentsOtherWho currently lives in your home?*Please list all individuals who live in your household by relationship. Examples: I live with my significant other and her two minor children. Is there anything else you would like to tell us about your current housing or living situation? Monthly IncomeList MONTHLY income from the following sources.EmploymentAllowanceChild SupportFamily SupportAlimonyTrustsInvestmentsDisabilityOther*Total Monthly Income*Explain other income. Monthly ExpensesList MONTHLY expenses from the following sources.Rent/MortgageUtilitiesCar PaymentCar InsuranceCell/Home PhoneInternet/CableRent/House InsuranceHealthcare InsuranceFood/HouseholdEntertainmentPersonal CareAuto Fuel/MaintenaceLegal ExpensesDebts/RestitutionCredit Card PaymentsLoan PaymentsChild SupportAlimonyChildcareTuitionOther*Total Monthly Expenses*Explain other expenses FINANCIAL ASSISTANCE CALCULATORIn this section, we will determine what resources you have available to you, and how much tuition assistance you will need. This information applies to the 2023-24 academic year, beginning in Summer 2023.Tuition and Education CostsPlease estimate how much your yearly educational costs are. The Next Step provides financial assistance for TUITION and BOOKS only. Do not include housing, laptops, living expenses, or other items in your estimates.What are your estimated annual tuition fees?*This is the total cost of tuition fees for Summer 2023, Fall 2023, and Spring 2024. If you're doing a certificate, vocational, or technical program, estimate the costs for one year of the program.What are your estimated annual book fees?*This is the total cost of books for Summer 2023, Fall 2023, and Spring 2024. If you're doing a certificate, vocational, or technical program, estimate the costs for one year of the program.Total Estimated Annual Educational CostsEducational ResourcesPlease list the total amounts of educational resources or financial assistance you expect to receive in the next academic year.ScholarshipsDo not include The Next Step scholarships.GrantsThis includes PELL Grants or Voc Rehab.Student LoansFederal and private student loans.Tuition ReimbursementFrom an employer or other sources.Family AssistanceAny tuition or loans from family.OtherAnything not included already.Total Anticipated Educational ResourcesFinancial Assistance RequestUsing your answers above, we would now like you to estimate how much assistance you will need. Undergraduate, vocational, and certification programs can receive a maximum of $5,000 and graduate programs can receive a maximum of $3,000. The average scholarship award is $2,800. Using these guidelines, how much assistance are you asking for each semester?Estimated Total Assistance NeededBased on your answers above, this is your estimated amount of tuition assistance needed this year. Undergraduate, vocational, and certification programs can receive a maximum of $5,000 and graduate programs can receive a maximum of $3,000. The average scholarship award is $2,800. Using these guidelines, how much assistance are you asking for each semester?Summer 2023 TuitionSummer 2023 BooksFall 2023 TuitionFall 2023 BooksSpring 2024 TuitionSpring 2024 BooksTotal Financial Assistance Requested EDUCATIONAL BACKGROUNDEducation CompletedCheck all that apply. High School GED Community College University Vocational/Technical School Military High School: Last Grade Completed GED: Select your progress None In Progress Completed Community College: Transfer Hours Community College: Degree Hours University: BS/BA Hours University: Master's Hours University: PhD Hours Vocational/Techical School: Courses Complete Military: Training Received EnrollmentAre you currently enrolled in school?* Yes No Where are you enrolled in school? What semester are you currently enrolled in? How many credit hours are you currently taking? How many hours will you take next semester? What is your major/field of study? What type of degree are you currently pursuing?Please select oneAssociate DegreeBachelor's DegreeMaster's DegreePhD/Doctoral DegreeVocational/Technical CertificateOtherWhat is your cumulative GPA? When do you expect to graduate? Grades from your last semester in school.Use the + sign to add additional courses.Course NameGrade Add RemoveWhat are your educational plans? Please tell us where you plan to enroll in school and what your major/field of study will be.Have you ever enrolled at this level of education before? Explain below. PERSONAL ESSAY QUESTIONS1. Describe your recovery journey.*2. What is your academic or vocational goal?*3. How will achieving this goal change your life or the life or others?*4. Explain why you need financial assistance. How will this scholarship help you?*5. Is there anything else you would like to share about yourself? Use this space for any additional information that will help us get to know you better.*6. Current PhotoPlease submit a current photo for our files. This is only used for verification purposes. If you cannot upload, please email to [email protected].Max. file size: 20 MB. CONSENT AND SIGNREAD THE FOLLOWING. CHECK AND SIGN TO ACKNOWLEDGE YOUR UNDERSTANDING OF THE REQUIREMENTS.*• I have read and understood the requirements and deadlines of the scholarship, 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 on 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. • I agree to keep the Board updated on pertinent issues and changes related to my recovery and education. • I agree to volunteer at the Annual Scholarship Dinner on October 7, 2023. If I cannot volunteer on that date, I will volunteer in another capacity to fulfill the volunteer requirement of the scholarship. • The Next Step does not and shall not discriminate on the basis of race, color, religion (creed), gender, gender expression, age, national origin (ancestry), disability, marital status, sexual orientation, or military status in any of its activities or operations. • 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. I agree to the requirements.Signature*Printed Name* Date* Month Day Year
