Educational Grant Application Date: ___/___/___
Applicant Information Contact Name: __________________________ Phone:__________________________ Address:______________________________________________________________________________ City:
__________________________
Email:__________________________ Age__________________________ Amount Requested: $ __________ School Semester : ___/___/___ to _/___/___
Email: _____________________________________________________Age:_________________
Amount Requested: $_________ School Semester : ___/___/___ to _/___/___
Designated Fund Applied to: Fran Milski Memorial Education Fund Margarita Challenge Education Fund General/Other Name of School:____________________________________________
What is the cost of tuition per semester:__________________
Student Matriculation No#:_________________________________ School Bank Acct #:________________________________________ How can we help you? __________________________________________________________ What are your goals and ambitions after your education? ______________________________ ________________________________________________________________________________ ________________________________________________________________________________ Why do you need help with your education? ____________________________________________ How can you donate back to the Jaltemba Foundation_____________________________________ ________________________________________________________________________________ ________________________________________________________________________________ Have you requested education funding from another resource? Yes No If yes, Name of Resource: ______________________Applied Received Pledged Denied
If denied, why?________________________________________ *REQUIRED: Attach three letters of reference and a report card with your latest marks and 2 copies of this completed application. Applicant Signature___________________________________________Date_______________
Jaltemba Foundation Email: marucadinsmore@aol.com
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