College for Life Scholarship Application

This is the joint scholarship form for the Jeff Burgess CFL Scholarship and the CFL Tuition Support Scholarship. Completing this application will allow you to be considered for both scholarships.

Student Information
Student's Name Student's Name First Last
Have you taken College for Life classes before?

Have you taken College for Life classes before? Yes No
Student's J# (returning student)
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Cell Phone Cell Phone - ### - ### ####
Email
Date of birth Date of birth / MM / DD YYYY
Do you have a parent/guardian/payee that supports you?

Do you have a parent/guardian/payee that supports you? Yes No
Parent/Guardian/Payee Information
Parent/Guardian/Payee Name Parent/Guardian/Payee Name First Last
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Cell Phone Cell Phone - ### - ### ####
Email
Statement of Financial Need
How many people live in your household?
Poverty Guidelines
Is your gross income above or below the 200% guideline?

Is your gross income above or below the 200% guideline? My gross income is below the guideline My gross income is above the guideline
Please describe how the College for Life program will impact or has impacted you.
Signature of applicant

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Today's Date Today's Date / MM / DD YYYY
Signature of parent/guardian/payee

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Today's Date Today's Date / MM / DD YYYY

College for Life Scholarship Application

College for Life Scholarship Application

Student Information

Parent/Guardian/Payee Information

Statement of Financial Need

Poverty Guidelines