Take Stock in Children Student Application

Step 1 of 8 – Student Information

Student Information

Name(Required)

First Last

Birthdate

MM slash DD slash YYYY

Social Security Number(Required)

Student ID(Required)

County(Required)

School(Required)

Grade(Required)

Phone Number(Required)

Email(Required)

Home Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Is your mailing address different from your home address?(Required)

Yes

Mailing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

How do you (the student) identify?

How do you (the student) identify?(Required)

Male

Female

Gender Diverse

Student Race(Required)

American Indian/Native American

Asian

Black/African American

Multiracial

Pacific Islander/Hawaiian

White

Other

Student Ethnicity: Is the Student of Hispanic, Latinx, or Spanish origin?(Required)

Yes

The Florida Prepaid College Foundation Scholarship Requirements:

Does the student have a Social Security #?(Required)

Yes

Are you (the student) a U.S. Citizen?(Required)

Yes

Is the student a resident alien?(Required)

Yes

Does the student have a Florida Prepaid College Foundation Scholarship Plan?(Required)

Yes

Household Information

Parent/Guardian 1

Parent/Guardian 1 Name(Required)

First Last

Phone(Required)

Email(Required)

Date of Birth(Required)

MM slash DD slash YYYY

Last Grade Completed in School(Required)

Do you have a second parent/guardian?(Required)

Yes

Parent/Guardian 2

Parent/Guardian 2 Name(Required)

First Last

Phone(Required)

Email(Required)

Date of Birth(Required)

MM slash DD slash YYYY

Last Grade Completed in School(Required)

Family Information

Applicant lives with:(Required)

Mother

Father

Stepmother

Stepfather

Grandmother

Grandfather

Guardian

Ward of Court

Other

If Other Please Specify

Number of Brothers(Required)

Number of Sisters(Required)

Please list all persons living in the home other than student/applicant (new line per person):(Required)

Independent siblings living outside the home (new line per person):

Parent/Guardian Employment Information

Employment Information

Name of Parent/Guardian (1)(Required)

First Last

Employer(Required)

Occupation

Address of Employer(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Number of Years with Current Employer

Gross Monthly Salary

Name of Parent/Guardian (2)

First Last

Employer

Occupation

Address of Employer

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Number of Years with Current Employer

Gross Monthly Salary

Income Information

Financial Information

What is your household income?(Required)

Are you eligible to receive any social services? (TANF, SNAP, Medicaid, etc.)(Required)

Yes

Please check the services you currently receive

Welfare/TANF

Food Stamps/SNAP

Medicaid

Are you currently receiving assistance from your local CareerSource Development Office?(Required)

Yes

Do you currently receive income from any other source for this student/applicant? (Social Security, child support, unemployment, etc?)(Required)

Yes

If yes, please list type of support and amount per month.

Do you or the student/applicant have a savings account?(Required)

Yes

Approximate balance?

Do you own your own home or rent your home?(Required)

Own my home.

Rent my home.

If you own, what is the amount of your monthly payment, and how much did your house cost?

If you rent, what is the amount of your monthly rent payment and how long have you been at your current address?

Upload Tax Return(Required)

Accepted file types: jpg, gif, png, pdf, doc, docx, pages, Max. file size: 30 MB.

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).

Student Information

To be completed by student.

List activities, interests, strengths, hobbies, awards you have received

Student Statement

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 list situations that might be relevant to school success

Please include your goals, aspirations, and hopes for your child’s future.

The factors listen below are used to determine your eligibility. Please check all that apply.(Required)

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:

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(Required)

Parent Signature(Required)

Date(Required)

How did you hear about us?

Take Stock in Children Student Application

Student Information

How do you (the student) identify?

The Florida Prepaid College Foundation Scholarship Requirements:

Household Information

Parent/Guardian 1

Parent/Guardian 2

Family Information

Parent/Guardian Employment Information

Employment Information

Income Information

Financial Information

Student Information

Parent/Guardian Statement

Signatures

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