Rotary Vocational Fund of Arizona Application

Your Name:

Address:

City, State, Zip: , AZ

Phone:  Home Work Cell

Email

Birthdate:

Social Security Number:

Name:

Relationship:

Phone:

If DEPENDENT report your Parents Total Household Income and Family Size, including you - OR - If INDEPENDENT report your Total Household Income and Family Size, including you.) This information will be verified from your completed FAFSA during the interview.

I am a:  Dependent Independent

Annual family income: Family size:

School name:

Address:

City, Zip: , AZ

School contact & title:

Contact Email:

Contact Phone:

Your area of study or career goal:

Estimated total cost of program (including tuition, fees, books, supplies, uniform, other - please specify):

Funding amount you are requesting (not to exceed $3,000) $

I would like to be considered for a TRVFA grant because:

What do you need to purchase?

Name and location of business where tools or materials will be purchased:

Business name:

Address:

City, State, Zip: ,

Estimated total cost of the tools or materials: $

Funding amount you are requesting (not to exceed $3,000) $

Rotary Club name:

Contact name:

Contact email:

I hereby certify that:

1. I am/will be: a Trade School student - or - an Associate Degree student - or - Tradesman
2. I meet the criteria of “Working Poor,” as recognized by the State of Arizona.
3. I am in need of financial assistance to develop my vocation.
4. The assistance received is to cover only the tuition, books, lab fees, tools/materials or similar required costs for my vocational training.
5. I have not ever been awarded funds from TRVFA.
6. I have sufficient financial resources to complete my educational program with this TRVFA grant.
7. I have not have obtained a Bachelors Degree from a college or university.
8. I am not a son or daughter of an active Rotarian.
9. I will promptly notify my sponsoring Rotary Club of any changes in my application.

I also agree:

1. To attend my sponsoring Rotary Club meetings when possible.
2. If all of the funds awarded are not used, then that balance will be returned to TRVFA by the training facility.
3. To keep my sponsoring Rotary Club informed of any change in address or telephone number.
4. To answer promptly all communications from my sponsoring Rotary Club.
5. To be an asset to my sponsoring Rotary Club, school and to myself.
6. That while the financial support is not requested to be repaid. I will consider, after I am established, to provide these funds to the TRVFA so as to help another individual.

I hereby authorize my training facility listed above to release information concerning my income, cost of tuition, fees, books, uniforms, tools, supplies, changes in my financial need, changes in financial aid received or expected to be received, including but not limited to grants, loans and scholarships; including grades and attendance data to the sponsoring Rotary Club and/or to TRVFA. I certify that the information contained herein and otherwise supplied by me is to the best of my knowledge and ability true and correct and may be relied upon by TRVFA and my sponsoring Rotary Club.