THE KREBSBACH CHARITABLE FOUNDATION

GRANT APPLICATION

 

Please TYPE the following:

Name:
Address:
City			State		Zip Code
Birth Date
Parent/Guardian Name:
Address: (if different then above)
City			State		Zip Code
Phone: Day			Phone: Evening
School					GPA
Year Graduated
Amount of Grant Request
Organization Name*
Address
City			State		Zip Code

*Funds will not be provided directly to the recipient.  Provide sufficient information regarding the organization is to be paid on your behalf if awarded a grant.

The application must be in the KCF Office ON or BEFORE either April 15 or October 15. Out of cycle requests will be considered on a case by case basis. These requests must be supported by specific reasons why the request should be handled outside the normal cycle.

Signature		Date
Parent/Guardian (if under 18 years)		Date

I.  How would this Grant contribute to your goals?

II. What are your sports or activity accomplishments?

(Outline your accomplishment in your sport, past and present.)

III. What are your athletic or activity goals?  (For this coming year and for the next five years.)

IV. What are your academic goals?

V. What are your community service accomplishments?

VI. Please outline your honors and activities.

VII. Income and Expense Data (provide for the most recent tax year)

PLEASE NOTE: If awarded this Grant, you may be asked to submit your most recent tax forms to verify your income information.  *If you leave a blank, it is in your best interest to explain why in the space provided (attach extra pages if necessary).  Please explain special circumstances, such as more than one student in college, excessive medical bills, or any other situations that would help the panel understand your financial need.

Family Annual Income
Family Annual Expenses
Unusual or Special expense items
Other (anything you wish to highlight)
Savings and Investments – non-retirement related
Home Mortgage
Other loans or debt
Estimated Net Family Worth

VIII. Other Information (Use this space to add any additional information or remarks you would like the committee to consider)

Date received:                                                                              

Action taken:                                                                                

Amount awarded:                                                                         

Date action taken: