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Who We Are
About Us
Partners
Success Stories
Get Involved
Mentor Application
Student Application
Donate
Contact
Students
Mentors
Donate
Who We Are
About Us
Partners
Success Stories
Get Involved
Mentor Application Form (Page)
Mentor Application
Student Application
Contact
Students
Mentors
Student Application
Fill out the form below or
Download the 2023-2024 Student Application
Student Information
-
Step
1
of 8
Student Name
*
First
Middle
Last
Date of Birth
*
Social Security #
*
Student ID
*
School
*
Grade
*
Student Phone
*
Student Email
*
Address
*
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Mailing Address Same
Check if mailing address is same as home address
Mailing Address
*
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Next
How do you (the student) identify?
Gender
*
Male
Female
Gender Diverse
Student Race
*
American Indian/Native American
Asian
Black/African American
Multiracial
Pacific Islander/Hawaiian
White
Other
If Other Please Specify
*
Student Ethnicity: Is the Student of Hispanic, Latinx, or Spanish origin?
*
Yes
No
The Florida Prepaid College Foundation Scholarship Requirements:
Does the student have a Social Security #?
*
Yes
No
Are you (the student) a U.S. Citizen?
*
Yes
No
Is the student a resident alien?
*
Yes
No
Does the student have a Florida Prepaid College Foundation Scholarship Plan?
*
Yes
No
Previous
Next
Parent/Guarian 1
Parent/Guardian
*
Parent Social Security #
Parent Phone #
*
Parent Email
*
Parent Date of Birth
*
Last Grade Completed in School
*
Parent/Guarian 2
Not applicable to student
Parent/Guardian (2)
Parent Social Security # (2)
Parent Phone # (2)
Parent Email (2)
Parent Date of Birth (2)
Last Grade Completed in School (2)
Previous
Next
Applicant lives with
*
Mother
Stepmother
Grandmother
Guardian
Father
Stepfather
Grandfather
Ward of Court
Other
If Other Please Specify
Number of brothers
*
Number of sisters
*
Please list all persons living in the home other than student/applicant (new line per person):
*
Name / Age / Relationship / Highest Level of Education
Independent siblings living outside the home (new line per person):
Name / Age / Relationship / Currently Attending School / Last Grade Completed
Previous
Next
Employment Information
Parent/Guardian (1) Current Employer
Name of Parent/Guardian (1)
*
Employer
*
Occupation
Address of Employer
*
Address Line 1
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Number of Years with Current Employer
Gross Monthly Salary
Before taxes and deductions.
Employment Information
Parent/Guardian (2) Current Employer
Name of Parent/Guardian (2)
Employer
Occupation
Address of Employer
Address Line 1
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Number of Years with Current Employer
Gross Monthly Salary
Before taxes and deductions.
Previous
Next
Financial Information
What is your household income?
*
Are you eligible to receive any social services? (TANF, SNAP, Medicaid, etc.)
*
Yes
No
Please check the services you currently receive.
Welfare/TANF
Food Stamps/SNAP
Medicaid
Are you currently receiving assistance from your local CareerSource Development Office?
*
Yes
No
Do you currently receive income from any other source for this student/applicant? (Social Security, child support, unemployment, etc?)
*
Yes
No
If yes, please list type of support and amount per month.
Do you or the student/applicant have a savings account?
*
Yes
No
Approximate balance?
Do you own your own home?
*
Yes
No
If yes, what is the amount of your monthly payment?
If yes, how much did your house cost?
Do you rent your home?
*
Yes
No
If yes, what is the amount of your monthly rent payment?
How long have you been at your current address?
Upload Tax Return
*
A complete copy of the most recent filed tax return Form 1040 must be attached with the student applicant listed as a dependent on the tax return in order to be eligible for consideration. (If you did not file taxes, please contact your local TSIC program).
Previous
Next
Student Information
To be completed by student.
List activities, interests, strengths, hobbies, awards you have received
Church, school, community, work experience, etc.
Student Statement
Please tell us about your goals, aspirations and hopes for your future.
Is there anyone in particular you would like to match with?
Parent/Guardian Statement
To be completed by parent(s)/guardian.
Apart from financial considerations, how could this program benefit your child?
Please include your goals, aspirations, and hopes for your child's future.
Please list situations that might be relevant to school success
Serious illness in the family, loss of employment, Department of Children and Families involvement, homelessness, etc.
The factors listen below are used to determine your eligibility. Please check all that apply.
*
Student attends a low-performing school (D or F rated school)
Single Parent
Incarcerated Parent
Deceased Parent
Absent Parent (no contact or support)
Poor relations between biological parents
Department of Children and Families involvement
Extended family in home
Extended family raising student
Student applicant is a teen parent
Parent was a teen parent
Family has received TANF benefits within past year
First generation college student
Student is first in the family to complete high school
Migrant worker
English not spoken in home
Loss of employment
Home in foreclosure
Homeless or living with extended family or friends
Serious illness in household
Disabled student or family member
Student is or has been in foster care
Other
If Other, please specify:
Previous
Next
Signatures
I understand that the information contained in this application is accurate and will be managed and implemented by the Local TSIC Lead Agency/TSIC Program and shared with the Local Lead Agency selection committee. I also certify thgat all information in this application is truthful and accurate and that I understand that any false information in this application may result in my child losing his or her eligibility in the program.
Student Signature
*
Date
*
Parent/Guardian Signature
*
Date
*
How did you hear about us?
Phone
Submit
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