Application Form - Scholarship Grant

Scholarship Application Form

Application Deadline - March 30, 2024
The Hope Scholarship was designed and developed to help break the cycle of incarceration in America. The program was founded to provide hope to young people who have dreams of higher education and seek to live a purpose-driven life. We believe that we can help break the cycle of the past by investing in the hope of the future.

If selected, you will be asked for documentation to support the data you provide. Likewise, all correspondence and award agreements will be generated from the personal information submitted below. So, please use proper spelling, capitalization and punctuation.
I. Personal Data:

Tell us about yourself
Full Name*

First NameLast Name
Birthdate:*

MonthDayYear
Mobile No. :*

Area CodePhone Number
E-mail :*
Where the confirmation will be send to
Home Address :*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Gender:

MaleFemale
Are you a US citizen?

YesNo
Status at the time of application:

I will be an incoming freshman graduating high school prior to 2021I am a GED graduate with no college credit hoursI will be going to a trade school
Are you a first generation college student ?

Yes, I am the first among my parents or grandparents to attend college.No, either my parents or grandparents have attended college.
Major Area of Study:
Please indicate what is your major are of study
What is your Career Objective:

0/300
Have you submitted an application for admission?

YesNo
II. Incarcerated Parent Info:
Parent Name:
Parent DOC #
Correctional Facility:
III. High School Information:
Are you or will you be a June 2024 high school graduate?

YesNo
High School Attended:
Year of High School Graduation or GED:
High School activities, community activities, volunteer work, honors, offices held:
IV. Extras:
(School Name) administers many scholarships designed to offer aid to students that represent unique characteristics. Please check each of the qualifiers below that apply to you. This data may increase your likelihood of qualifying for selected scholarships. Please note, if you are awarded a scholarship based on any of these qualifiers, you will be asked to produce documentation verifying your unique eligibility.
Have you ever received a scholarship?

YesNo
Do you plan to complete your two-year degree?

YesNo
Do you plan on going to a trade school instead of a traditional college?

YesNo
Do you plan to transfer to another college and complete a 4-year degree?

YesNo
Will you be working while attending?*

YesNo
If so, will you work:

Full-timePart-time
V. Essay
Your essay should be 300-500 words. You should address in your essay: your college goals and choice of major, what you intend to do with your education, and why a scholarship is important to you. Include any academic and non-academic accomplishments, personal characteristics, or experiences that make you uniquely worthy of scholarship consideration.
Essay:

0/500
VII. Applicant's E-Signature
By signing (typing your legal name) in the space below, you are certifying that all information is correct and that you are the person completing this application. When you press the submit button, you will receive an email confirmation that your application was received. Please print for your records and retain as verification of your application.
E-Signature:*
Breakloose Inc is committed to equal opportunity in employment and education. The sponsorship program does not discriminate in any program or activity on the basis of race, color, religion, gender, age, national origin, disability, marital status, or any other protected class.
Should be Empty:

Scholarship Application Form

I. Personal Data:

II. Incarcerated Parent Info:

III. High School Information:

IV. Extras:

V. Essay

VII. Applicant's E-Signature