thank you for your interest in the jvs scholarship program! scholarship application form...
TRANSCRIPT
JVS Scholarship Application
Thank you for your interest in the JVS Scholarship Program!
Please fill out the following information.
Note: You may fill out this form electronically. If you are not able to fill out the form electronically, you may print and fill it out. However, please note that we prefer the electronic format. If you need access to a computer
to fill out this form, please contact Raza Handan at [email protected].
Date: _____/_____/_____
Last Name First Name
Street Number Street Name Apt #
City Zip Code
Phone (home) Phone (cell)
E-mail Address
What is your date of birth (mm-dd-yyyy) -
1. Are you currently a JVS client? Yes No
If yes, who is your JVS employment specialist? _____________________________________________
2. Where did you find out about the JVS scholarship program?
Public agency (e.g., EDD, Onestop, Human Services Agency, Dept. of Rehabilitation) (specify) ________________________________________
School (e.g., City College, SFUSD, community college) (specify)
______________________________________________
Community event (e.g., job fair, street fair) (specify) ________________________________________
Jewish organization (e.g., Jewish Family and Children’s Services, synagogue, JCC)
(specify) ________________________________
Other social service agency or community organization (e.g., Goodwill, Toolworks, CVE)
(specify) ___________________________________
JVS (website, internet, staff) (specify) __________________________________
Employer (specify) ________________________________________
Media (newspaper, internet, radio) (specify) _______________________________________
Friend/family member/co-worker Other (specify) _______________________________________
3. What is your religion? __________________________________________________________________________________
4. Are you authorized to work in the US? Yes No
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Initials:______________ Date: _____________
Section A: Career Goal
CAREER GOALS
1. Please describe your career goal. How is this goal a fit for you? What are the current and long-term
prospects for you in this career field?
2. Have you already started looking for work in this field? Yes No
If yes, how long have you been looking? ______________________________________
3. What type of job/job title(s) are you currently interested in? (Please specify up to three titles
actively used by employers in your target field).
Note: You should refer to www.onetonline.org to obtain the O*NET description. The O*NET description might vary slightly from the job titles employers or training providers use. Please select the closest match.
Section A continued on page 3
Occupational Title:
__________________________________
__________________________________
__________________________________
O*NET Description
_________________________________
_________________________________
_________________________________
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Initials:______________ Date: _____________
Section A: Career Goal
4. Which of the following categories best describes the type of employment industry you are
currently interested in? (Check one)
Finance and Business Tech
Office High-level:
Sales:
Hospitality Non-profit/Education
Office Entry, Mid-level:
Healthcare
5. What skills and experience do you have that makes you competitive for the industry and job you are
looking for? (Describe)
7. Please attach to this application up to five job postings related to your target job.
Tip: Target job postings that highlight the need for the training program you are pursuing.
8. Do you intend to seek employment concurrently with or immediately upon completion of your
training? Yes No
Please proceed to Section B: Training Plan
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Initials:______________ Date: _____________
Section B: Training Plan
1. Please provide the following information about your proposed training program:
Course of Study
Degree/Certification Earned at Training Completion
Name of Training Provider/School
Training Provider/School Location
Cost of Training Program
Start Date/End Date
Back-up Start Date/End Date (optional)
Back-up Training Provider/School (optional)
2. Please describe the connection between your training program and your job goal. Is the training a
prerequisite to obtaining the job? If the training is not a prerequisite, please describe why this training
program would position you better as a job seeker.
Section B continued on page 5
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Initials:______________ Date: _____________
Section B: Training Plan
3. Will you be required to pass a certification exam after the training program to be eligible for work?
Yes No
4. Please attach a school/program brochure or any other form of information that speaks to the qualifications
of the training provider (you may also copy and paste information into an electronic document).
Please proceed to Section C: Employment and Education Background
3a. When will you take the exam? ____________________________________________________________________________________________________________________________________________________________
3b. Is the cost of the exam included in the cost of the training program?
If no, how will you cover the cost of the exam?
__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
3c. Is there any other information you would like to provide regarding the certification exam?
__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
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Initials:______________ Date: _____________
Section C: Employment and Education Background
1. Please attach a current and targeted resume to this application.
2. Please provide the following information about your employment history (start with the most recent job).
Name of employer
Job Title Location Dates employed Supervisor
3. Which of the following best describes your high school, college or graduate school education
level? (Check only the highest level)
High school/
GED classes.
Never attended
Stopped attending
Currently enrolled/attending
Graduated/completed
Diploma
GED
Country of Issue (leave blank if United States)
College (including community college, state college or university).
Stopped attending
Currently enrolled/attending
Graduated/completed
Associates (AA)
Bachelors’ (BA, BS)
Other (specify)
___________________
Country of Issue (leave blank if United States)
Graduate school.
Stopped attending
Currently enrolled/attending
Graduated/completed
Masters’ (MA, MS, MBA)
Doctorate (PhD, MD, JD)
Other (specify)
___________________
Country of Issue (leave blank if United States)
4. Please provide information about your trade/technical school education if applicable:
Trade/technical school (e.g., computer, automotive, electrical, cosmetology).
Stopped attending
Currently enrolled/attending
Graduated/completed
specify field of study__________
__________________________
__________________________
Section C continued on page 7
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Initials:______________ Date: _____________
Section C: Employment and Education Background
5. Please provide information about any occupational certifications and/or licenses you have?
Type of Certificate/License Issue Date
Expiration Date (write N/A if not
applicable)
Was this issued in the United States?
Yes - US No-not US
Yes - US No-not US
Yes - US No-not US
Yes - US No-not US
Please proceed to Section D: Financial Need
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Initials:______________ Date: ____________
Section D: Financial Need
1. What is your employment status: Employed Unemployed Under-employed
Notes:
2. What is the source of your monthly income?
Part-time Employment Savings
Full-time Employment School Scholarship
CALM (Cash Assistance Linked to Medi-Cal) SDI (State Disability Insurance)
CAPI (Cash Assistance Program for Immigrants) SSA (Social Security Administration – Retirement)
Child Support SSDI (Social Security Disability Insurance)
Family Resources SSI (Supplemental Security)
Financial Aid/Grant for School SSIP (Supplemental Security Income Pending)
Food Stamps TANF/Calworks
GA (General Assistance) Training Stipend
Income of Spouse/Partner Unemployment Benefits
JFCS Financial Assistance Veteran’s Benefits
PAES (Personal Assisted Employment Services) Worker’s Comp
RCA (Refugee Cash Assistance) Don't Know
Retirement/Pension Other: ______________________________________
3. Do you have any dependent family members? Yes No
If yes, how many dependent family members do you have? _______________
4. Please indicate the members of your household:
Spouse
Children (how many? _______________)
Parents (how many? ________________)
Other (please explain: ___________________________________)
Notes:
Section D continued on page 9
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Initials:______________ Date: ____________
Section D: Financial Need
5. Do you have any outstanding loan obligations? Yes No
If yes, please indicate the source and amount: _____________________________________
6. Gross Income for Family
Household Member
Source of Income
Hrs/ Week*
$/Hr* Monthly Gross** Income
Previous Year’s Income
Applicant -- $ $ $
-- $ $
Spouse -- $ $ $
-- $ $
Child -- $ $ $
-- $ $
Child -- $ $ $
-- $ $
Parent -- $ $ $
-- $ $
Parent -- $ $ $
-- $ $
Other: -- $ $ $
-- $ $ $
Total $ $
*When applicable **Before taxes
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Section D continued on page 9
Initials:______________ Date: ____________
Section D: Financial Need
1. Household Budget Summary: Estimated expenses and income for the time period for which grant is
being requested
Period of Time: From to Number of Months:
EXPENSES
Description Comments Monthly (when applicable)
Total Amount
Tuition $ $
Fees $ $
Books $ $
Study Transportation $ $
Family Transportation $ $
Rent $ $
Utilities $ $
Food & Personal $ $
Clothing $ $
Medical $ $
Loan Payments $ $
Other: $ $
Other: $ $
Total Expenses: $
INCOME
Description Comments Monthly (when applicable)
Total Amount
Student Savings: $ $
Anticipated Net Job Earnings $ $
Public Assistance: $ $
GA/RCA $ $
AFDC $ $
MBG $ $
SSI $ $
Food Stamps $ $
Family Contribution: $ $
Other (e.g. spouse income): $ $
$ $
Subtotal Income: $
Scholarship Grants: $ $
Name: Pending Approved $ $
Scholarship Loans $ $
Name: Pending Approved $ $
Total Income: $
2. Difference between income and expenses: $
3. Amount requested from JVS: $
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Initials:______________ Date: ____________
Section E: Statement of Purpose
Thank you for providing the above information. The Scholarship Committee weighs a variety of factors when determining who will most benefit from the scholarship funds available. These factors include:
the marketability of your job goal
your competitiveness for the job goal
the training program must be vocational
the training must be short term, or at least be used for the end of a longer-term training program
the strength of the vocational training program
the connection between the vocational training and job prospects
your financial need
your likelihood of completing the training and obtaining work soon thereafter
With these factors in mind, please provide a statement of no more than 500 words that addresses your fit for this program based on the above information. You may use the space below, or attach in a separate document.
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Initials:______________ Date: ____________
Section E: Statement of Purpose
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Initials:______________ Date: ____________
Section F: Final Checklist
The following items are required to submit a complete application (please check below if complete):
Section A: Career Goals
Section B: Training Plan
Section C: Employment and Education Background
Section D: Financial Need
Section E: Statement of Purpose
Attach up to 5 Job Postings (on paper or copied into an electronic document)
Attach a current and targeted resume
Attach information about the school and program of study (e.g. brochure, copy and paste information from the website in an electronic document, etc).
Signature (below)
Please note that the scholarship application must be completely filled out to be considered by the committee. I hereby affirm that the information I provided on this application is complete and accurate. I understand that any falsification can be grounds for immediate rejection of my application. __________________________________________________________________________________________ Print Name Signature Date
Thank you for your application to the JVS Scholarship Program!
If you have any further questions about your application, please contact Raza
Handan at [email protected], or (415) 782-6263.