Grupe Foundation Application – Grupe Foundation

Name *

First

Last

Permanent Home Address *

Address Line 1

City

State

Zip Code

Best Phone Number *

Best Email *

Confirm Email

U.S. Citizen *

You Must Be a US Citizen to Apply

Upload Proof Of Citizenship (Passport, U.S. Military ID, or U.S. Drivers license) *

Click or drag a file to this area to upload.

Acceptable File Formats: (.pdf, .doc, .png, .gif, and .jpg) Max Upload Size 10MB

Section 1 Personal

If Any Line Item Doesn't Apply Please Enter NA

Place & Date of Birth *

Social Security Number *

Sex *

Male
Female
Other

The William F Grupe Foundation, Inc. prohibits any discrimination against applicants on the basis of sex, marital status, race, color, or creed

Marital Status *

Married
Single
Divorced

Names and Ages of Dependents & Their Relationship To You *

Give 2 Personal References Other Than Family *

First

Last

1st Reference Address

Address Line 1

City

State

Zip Code

2nd Personal Reference Other Than Family *

First

Last

2nd Reference Address

Address Line 1

City

State

Zip Code

Section 2 Family

Name of Mother *

First

Last

Name of Father *

First

Last

Address of Parents *

Address Line 1

City

State

Zip Code

Click Here If You Need To Enter Another Address For Your Parents

I need to add another address for my parents

Address

Address Line 1

City

State

Zip Code

Occupation of Father *

Father's Gross Yearly Income *

Occupation of Mother *

Mother's Gross Yearly Income *

Click Here If Both Of Your Parents Are Deceased

Both Of My Parents Are Deceased

If Both Parents Are Deceased Provide Information For The Closest Living Relative Other Than Your Spouse

Estate Value If Deceased

Name of Closest Living Relative

First

Last

Address of Closest Living Relative

Address Line 1

Address Line 2

City

State

Zip Code

Did Or Will Applicant Reside With His/Her Parents or Legal Guardian During Any Of The Below Calendar Years

If Multiple Years Then Select The Most Recent Year That Applies

Click Here If Applicants Parents Have Other Children Who Depend On Them For Education

Yes My Parents Have Other Children Who Depend on Them For Education

Total Number Of Other Children Dependent For Education

Enter Ages and Current Educational Status For Each Child

Section 3 Education

Grammar School *

First

Middle

Last

High School *

First

Middle

Last

College

First

Middle

Last

College Degree Obtained

Medical, Nursing or Paramedical School

First

Middle

Last

What Are Your Educational Plans For The Future? *

Medical Doctor
Nurse

At Which School Have You Been Accepted And Plan To Attend Or Are Now Attending? *

When Do You Expect To Graduate? *

How Long Is The Training Program In Which You Are Enrolled Or Are Planning To Enroll? *

Section 4 Financial

All Items In This Section Refer To The Applicant

Home Equity Assets

Automobile Assets

Bank Savings Accounts

Name and Address of Savings Bank *

First

Last

Bank Checking Accounts

Name and Address of Checking Bank *

First

Last

If same as savings enter SAME in both fields

Other Financial Assets

Please Itemize Assets One Per Line

Explain Possible Use Of These Assets For Financing Your Education

Make and Year Of Car(s) Applicant Owns And Drives For Personal Use *

First

Middle

Last

Make and Year Of Car(s) Applicant Owns And Drives For Personal Use 2

First

Middle

Last

Educational Loans *

First

Middle

Last

Date Loan Incurred

Loan Due Date

If You Have More Than 1 Educational Loan Click Here

I Have More Than 1 Loan

Educational Loans (2)

First

Middle

Last

Date Loan Incurred (2)

Loan Due Date (2)

Non-Educational Loans *

First

Middle

Last

Purpose Of Loan

Date Loan Incurred

Loan Due Date

If You Have More Than 1 Non- Educational Loan Click Here

I Have More Than 1 Non-Education Loan

Non-Educational Loans (2) *

First

Middle

Last

Purpose Of Loan (2)

Date Loan Incurred (2)

Loan Due Date (2)

Add Another Non-Educational Loan

I Need To Add Another Non-Educational Loan

Non-Educational Loans (3)

First

Middle

Last

Purpose Of Loan (3)

Date Loan Incurred (3)

Loan Due Date (3)

Anticipated Start Date This Grant Is To Be Used *

Anticipated End Date This Grant Is To Be Used *

Expenses During The Anticipated Use Period *

Tuition and Fees

Books and Supplies *

Books and Supplies

Food *

Food

Transportation and Auto Expenses *

Transportation

Other Expenses

First

Last

First

Last

Total Expenses *

$ Add Your Totals From Each Expense Line Item Above

Resources During The Anticipated Use Period *

Gross Earnings

Other Income *

Other Income

Savings *

Savings

Family Gifts

Scholarships

Scholarship Amount

Family Loans

Other Loans

Total Resources *

$ Add Your Totals From Each Resource Line Item Above

Total Deficit *

Subtract Total Expenses From Total Resources

How Much Financial Aid Are You Requesting From The Grupe Foundation? *

Section 5 Employer Information

Where Do You Expect To Practice After Completion Of Your Training?

Are You Currently Employed? *

Full Time
Part Time
Not Currently

Gross Weekly Earnings

Name of Employer

Address of Employer

Address Line 1

City

State

Zip Code

Is Your Spouse Currently Employed? *

Full Time
Part Time
Not Currently
I Don't Have a Spouse

Gross Weekly Earnings (spouse)

Name of Employer (spouse)

Address of Employer (spouse)

Address Line 1

City

State

Zip Code

Set Forth Any Additional Factors, Financial Or Otherwise, Which You Feel The Grupe Foundation Should Take Into Consideration in Reviewing Your Application

Confirmation and Agreement

Please Confirm The Following: *

I Have Answered All Of The Questions In Full
I Have Requested 2 Letters of Recommendation (1 Attesting Financial Need, 1 Attesting Scholastic Ability) To Be Sent Directly To The Grupe Foundation or Have Uploaded Below

The William F Grupe Foundation Inc. PO Box 775 Livingston, NJ 07039 or Barbara@GrupeFoundation.com

Upload Your Letter Of Recommendation Attesting To Your Financial Need

Click or drag a file to this area to upload.

Max File Size is 5MB Only .pdf and .doc File Formats Accepted

Upload Your Letter Of Recommendation Attesting To Your Scholastic Ability

Click or drag a file to this area to upload.

Max File Size is 5MB Only .pdf and .doc File Formats Accepted

We, The Undersigned, Certify That To The Best Of Our Knowledge, The Information Contained In This Form Is Correct, And Agree To Supply The William F Grupe Foundation, Inc, Upon Request, With An Official Copy Of Our Latest Federal Income Tax Return. And If My Resources Are Dependent Upon Parental Help, Upon Request, A Copy Of My Parents' Latest Federal Income Tax Return Will Be Furnished. This Information Will Be Kept In Strict Confidence *

I Agree And Understand

Type Your Name Below To Agree and Submit Your Application *

Thank You For Looking To The William F. Grupe Scholarship Foundation

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Please Start Your Online Application Below

Section 1 Personal

Section 2 Family

Section 3 Education

Section 4 Financial

Section 5 Employer Information

Confirmation and Agreement