~ FOUNDATION ANTHONY MUNOZ SCHOLARSHIP FUND APPLICATION ~ FOUNDATION ANTHONY MUNOZ SCHOLARSHIP FUND ELIGIBILITY REQUIREMENTS APPLICANTS MUST: Be a graduating high school senior with a minimum 3.0 grade point average or a minimum composite ACT score of 18 Attend a high school in the Tri-State region, defined as the counties of: a Kentucky – Boone; Bracken; Campbell; Gallatin; Grant; Kenton b Indiana – Dearborn; Franklin; Ohio; Switzerland; Union c Ohio – Brown; Butler; Clermont; Clinton; Greene; Hamilton; Highland; Montgomery; Preble; Warren Have freshman standing by the fall of 2019 Be a student entering an accredited Tri-State college or university – see list of eligible schools [Next Page] Demonstrate a desire and intent to overcome adversity, have financial need, excel academically, and fulfill a leadership role in the community Interview with member(s) of the Anthony Muñoz Foundation Scholarship Fund selection committee if chosen as finalist Attend the award ceremony held on Sunday, June 9, 2019, in Mason, OH Complete, and submit to the Anthony Muñoz Foundation , all required materials within the stated deadlines for consideration of the award If chosen as a winner, must maintain full-time student status and cumulative grade point average above 2.5 NECESSARY DOCUMENTS: The Anthony Muñoz Foundation holds the right to reject applications if all necessary documents are not included, if documents are not completed to their entirety, or if all documents are not submitted together Scholarship application form Personal Essay Acceptance letter from intended college or university-if available College or university student ID #-if available A high school transcript for the entirety of high school career up to date of application submission Current financial information for family This includes your SAR Report and the financial sheet in this packet IMPORTANT DATES Application Process Opens: January 1, 2019 **Application Deadline: May 1, 2019 Seminfinalist Interviews: May 2019 Finalist Announced By: May 30, 2019 **[All required documents including transcript and FAFSA (or other financial information) must be received by the Committee no later than May 1, 2019.] SUBMIT YOUR APPLICATION MAIL APPLICATION TO Anthony Muñoz Foundation 8919 Rossash Road Cincinnati, Ohio 45236 Attn: Victoria Knepp OR SCAN + EMAIL APPLICATION TO impact@munozfoundation.org OR FAX APPLICATION TO (513) 772-4911 Questions? Email Victoria Knepp vknepp@munozfoundation.org Or Visit Our Website munozfoundation.org [PLEASE KEEP THIS PAGE FOR YOUR RECORDS.] ~ FOUNDATION ANTHONY MUNOZ ELIGIBLE SCHOLARSHIP FUND COLLEGES/UNIVERSITIES OHIO • • • • • • • • • • • • • • • • Art Academy of Ohio- Cincinnati Cedarville University Central State University Christ College of Nursing Cincinnati Christian University Cincinnati State Technical and Community College Clark State Community College College of Mount St Joseph Miami University Sinclair Community College University of Cincinnati University of Dayton Wilmington College Wittenberg University Wright State University Xavier University KENTUCKY • Georgetown College • Northern Kentucky University • Thomas More College INDIANA • • • • Earlham College Hanover College Indiana University East Purdue University College of Technology- Richmond *STUDENTS MUST BE PURSUING A BACHELOR’S DEGREE SCHOOLS WERE CHOSEN BASED ON PROXIMITY FROM CINCINNATI, OHIO DETERMINED BY SCHOLARSHIP FUND COMMITTEE MEMBERS IF YOUR SCHOOL IS NOT LISTED OR YOU HAVE ANY QUESTIONS, ~ FOUNDATION AT VKNEPP@MUNOZFOUNDATION.ORG PLEASE CONTACT THE ANTHONY MUNOZ ~ FOUNDATION ANTHONY MUNOZ SCHOLARSHIP APPLICATION FORM (Please Type Or Print) GENERAL APPLICANT INFORMATION Name of Applicant (First & Last): Date of Birth: Gender: Race (Please Choose One): American Indian or Alaska Native Asian Caucasian African American Other: Status (Please Choose One): U.S Citizen Non U.S Citizen National or Permanent Resident Other Birthplace (city/state/country): Permanent Address: City: State: Zip Code: Phone No: Email Address: *Please note: All application status updates will be sent to the above email High School: Intended College / University: Intended Major: How Did You Hear About This Scholarship Opportunity? (Name of Website, or Person & Affiliation, etc.) ~ FOUNDATION ANTHONY MUNOZ SCHOLARSHIP APPLICATION FORM CONTINUED (Please Type Or Print) HIGH SCHOOL EXPERIENCE Employment History: Please attach any additional information should it be necessary Employer: Position: Hours/Week: # of Years Worked: Employer: Position: Hours/Week: # of Years Worked: Employer: Position: Hours/Week: # of Years Worked: Employer: Position: Hours/Week: # of Years Worked: School and Community Activities + Years: ~ FOUNDATION ANTHONY MUNOZ SCHOLARSHIP APPLICATION FORM CONTINUED (Please Type Or Print) FINANCIAL INFORMATION Living? Father’s Name: Age: Yes: No: Mother’s Name: Age: Yes: No: Legal Guardian’s Name: Age: Yes: No: With Whom Do You Live? (E.g mother and father, father alone, mother alone, mother and stepfather, etc.) Parents’ Marital Status: Married Divorced Separated Single Widowed Father’s Gross Income $ Place of Employment: Mother’s Gross Income $ Place of Employment: Other/Legal Guardian’s Gross Income $ Place of Employment: Your Gross Income $ Place of Employment: Social Security (family total) $ ADC or Public Assistance $ Child Support: Court Determined Amount: $ Actual Amount Received: $ Pensions $ Unemployment Benefits $ Other Income (from rentals, interest, dividends, inheritance) $ Total Yearly Household Gross Income .$ Savings Account Totals $ ~ FOUNDATION ANTHONY MUNOZ SCHOLARSHIP APPLICATION FORM CONTINUED (Please Type Or Print) FINANCIAL + FAMILY INFORMATION Number of Children Living at Home (Including Applicant): Ages: Number of Family Members Attending College in the Fall: Do the Applicant’s Guardians Own Their Home? YES: NO: Purchase Price: Year Purchased: Amount Still Owed on it: Current Value: For the below questions, please use your birth or adoptive parent’s information Father Highest Education Level Completed: High School Associates Bachelors Masters Other Masters Other Mother Highest Education Level Completed: High School Associates Bachelors 2019 FORECAST AND UNUSUAL CIRCUMSTANCES Does your family anticipate that your 2019 financial figures will change significantly from the 2018 figures provided on this form? Yes No If yes, or if there is anything significant about your family’s financial circumstances that is not reflected in your prior responses (e.g high uninsured medical expenses, expected changes in employments), please provide specific details below, including estimated dollar amounts Attach a separate page if needed ~ FOUNDATION ANTHONY MUNOZ SCHOLARSHIP APPLICATION FORM CONTINUED (Please Type Or Print) GRANT OR SCHOLARSHIP NOTIFICATIONS List any awards applied for below Please attach any additional information should it be necessary Scholarship/Grant Name: Is This Award: Pending Amount: Received Will This Award be Granted: Scholarship/Grant Name: Is This Award: Pending Received Will This Award be Granted: Other One Time Yearly Other Yearly Other Yearly Other Amount: Received Will This Award be Granted: Scholarship/Grant Name: Is This Award: Pending Yearly Amount: Scholarship/Grant Name: Is This Award: Pending One Time One Time Amount: Received Will This Award be Granted: One Time CERTIFICATION We certify that, to the best of our knowledge, all information and statements on this form are current, complete, and accurate We understand that all figures are subject to verification, and we agree to provide, if requested, official copies of federal tax statements and other documents In addition, we agree that if the applicant is accepted for the program, we will submit the Free Application for Federal Student Aid (FAFSA) as soon as possible If the Anthony Muñoz Foundation learns that the income figures reported on the FAFSA differ significantly from those reported here, or any information provided on this document is found to be false, the Anthony Muñoz Foundation reserves the right to adjust or withdraw the student’s scholarship award Student Name (Please Print) Parent or Legal Guardian Name (Please Print) Student Signature Parent or Legal Guardian Signature Date Date ~ FOUNDATION ANTHONY MUNOZ SCHOLARSHIP APPLICATION FORM CONTINUED (Please Type Or Print) PERSONAL ESSAY Please respond to the following question There is no minimum or maximum length requirement for your response Please attach any additional sheets if necessary (Typed format is preferred, but not required) Describe any personal hardships or unusual circumstances you have had to overcome How have these experiences shaped you as a person, and how can they help you in the future? ... Application Process Opens: January 1, 2019 * *Application Deadline: May 1, 2019 Seminfinalist Interviews: May 2019 Finalist Announced By: May 30, 2019 **[All required documents including transcript... later than May 1, 2019. ] SUBMIT YOUR APPLICATION MAIL APPLICATION TO Anthony Muñoz Foundation 8919 Rossash Road Cincinnati, Ohio 45236 Attn: Victoria Knepp OR SCAN + EMAIL APPLICATION TO impact@munozfoundation.org... of application submission Current financial information for family This includes your SAR Report and the financial sheet in this packet IMPORTANT DATES Application Process Opens: January 1, 2019