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About
Application
Contact
Scholars

About
Application
Contact
Scholars

Scholarship Application

Application Deadline: April 15, 2022

For information contact:

Melanie Montalto, Program Coordinator, Melanie.montalto@jandonscholars.org, 718-637-4873

Leslie Cecil, leslie.cecil@jandonscholars.org

Alec Cecil, alec.cecil@jandonscholars.org

If you’re not able to finish the application in one sitting, you can return to it later by clicking the “Save and Continue Later” link at the end of the application.

Scholarship Application 2022

Personal Information
Name*
First Last
Address*
Street Address City State ZIP Code
Phone 1*
Phone 2
Are you a U.S Citizen or permanent resident?*
- yes
- no
If not, explain
Social Security Number*
Date of Birth*
School Information
Name of High School*
Expected Date of Graduation*
Cumulative GPA*

(Grades 9, 10, 11, 12-1st semester)
SAT Scores
ACT Scores
NOTE: Proof of GPA and Scores must be enclosed. Please submit single-sided documents only. Submit at the end of this application.
Family Information
Parent/Guardian 1*
Name
Relationship*
- Mother
- Father
- Legal Guardian
- None
Mailing Address*
City/State/Zip*
Occupation*
Employer*
- Part-time
- Full-time
Parent/Guardian 2
Name
Relationship
- Mother
- Father
- Legal Guardian
- None
Mailing Address
City/State/Zip
Occupation
Employer
- Part-time
- Full-time
Household Size & Annual Income
Household Size*
- 1 persons
- 2 persons
- 3 persons
- 4 persons
- 5 persons
- 6 persons
- 7 persons
- 8 or more persons
Annual Income*
- $23,828 or less
- $32,227 or less
- $40,626 or less
- $49,025 or less
- $57,424 or less
- $65,823 or less
- $74,222 or less
- $82,621 (or less); plus $8,399 for each family number in excess of 8
If you need to provide other information about your family, household size or annual income, please explain in the space below:
If you need to provide other information about your family, household size or annual income, please explain in the space below:
Income Verification
Is your family receiving public assistance?*
- Yes
- No
If yes, indicate case #
Did you apply for Tap or Pell Grants?*
- Yes
- No
Did you apply for EOP/HEOP or SEEK?*
- Yes
- No
Have you filed your FAFSA?*
- Yes
- No
With whom did you reside in the last 12 months?
Name*
Relationship to student*
Mailing Address*
Street Address City State ZIP Code
Phone 1*
Phone 2
Were you claimed as a deduction on the above referenced person's income tax return?*
- Yes
- No
If no, please provide information for the person who claimed you as a dependent:
Name
Relationship to student
Mailing Address
Street Address Address Line 2 City State ZIP Code
Home Phone
Cell Phone
Occupation
Employer
IMPORTANT
Provide the following information:
- Student Aid Report (SAR) from the FAFSA submitted.
- Financial Award Letter from the college/university you plan attend.
- If your income cannot be verified by these forms, please attach a separate document explaining your financial circumstances.
- You will have the opportunity to upload all documents at the end of this form.
Guidance Counselor Information
Name*
Phone*
Email*
Recommendation Letters
Specify below a school and a community reference who will provide recommendation letters.
NOTE: Upload both letters at the end of your application.
School Reference (Guidance Counselor, Teacher, Principal, or Coach)
Name*
Name
Title*
Title
Phone*
Phone
Community Reference (Work Supervisor, Religious Leader, etc.)
Name*
Name
Title*
Title
Phone*
Phone
College Applications
Please list colleges to which you have applied.
1.*
2.
3.
4.
Essay
Please provide a 250-500 word essay in response to either (A) or (B) below. Please submit single-sided documents only.
(A) Choose one extracurricular or community activity that you are involved in and tell us why it is significant to you. Or (B) Submit one essay that you submitted as part of a college application. This may be on any topic.*
(A) Choose one extracurricular or community activity that you are involved in and tell us why it is significant to you.
Or
(B) Submit one essay that you submitted as part of a college application. This may be on any topic.
Max. file size: 512 MB.
Transcript, Honors, Activities
Please attach a copy of: (1)    Your first semester grades, high school transcript, including all regents scores, SAT, and ACT. (2)    Your extracurricular, community, or any other activities.*
Please attach a copy of:
(1)    Your first semester grades, high school transcript, including all regents scores, SAT, and ACT.
(2)    Your extracurricular, community, or any other activities.
Drop files here or

Max. file size: 512 MB.
Recommendation Letters
Please attach a copy of: The recommendation letters as outlined earlier.*
Please attach a copy of:
The recommendation letters as outlined earlier.
Drop files here or

Max. file size: 512 MB.
Student Aid Report (SAR) and Financial Award Letter
Please attach a copy of: Student Aid Report (SAR) and Financial Award Letter.*
Please attach a copy of:
Student Aid Report (SAR) and Financial Award Letter.
Drop files here or

Max. file size: 512 MB.
Please review your responses and make sure you have attached all required documents before submitting.
You will not be able to submit your application if you left any required fields blank.
Electronic Signature*
By entering your name here you attest to the accuracy of your application.
Date*
MM slash DD slash YYYY

Save and Continue Later

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