Hope Scholarship 2025 - Special Love

Name

First Last

Gender Identity

Date of Birth

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home Phone

Cell Phone

Special Love cofounder, Tom Baker, often said, "when a child is diagnosed with cancer, the whole family is impacted." How has your family's experience with cancer impacted you?

Special Love Involvement

Please indicate what Special Love programs you participated in, and years participated.

BRASS Camp

Years Attended:

BRASS Weekend

Years Attended:

OctoberFest Weekend

Years Attended:

Ski Family Weekend

Years Attended:

Summer Family Day

Years Attended:

Other:

Years Attended:

Section B: College/University/Trade School Information

Name and address of school to whom you have formally committed and are planning to attend. OR If you have not yet chosen a school, list any to which you have applied. Be aware a scholarship award will not be provided until you have provided evidence of enrollment.

Are you entering your junior year of college (or later)?

Yes

If answer is no, you do not meet the qualifications necessary for application. Please terminate your application until you meet all qualifications.

School Name(s) & Address

Student ID #

Degree and/or Area of Study:

Have you applied to the above?

Yes

Have you been accepted?

Yes

Is this a graduate level program?

Yes

When is tuition due at the institution? Indicate Fall & Spring Semester's due dates.

Tuition cost per credit hour:

Average number of credits you plan to take per semester:

Are you financially independent and responsible for your own cost of living?

If you answered yes, you yourself should complete the financial information.

If not living at home, what is your housing cost per semester:

Do you live with your parent(s)/guardian(s) when not at school?

If you answered yes, your parents/guardians should complete the financial information.

Financial Support

Your application will NOT be reviewed if the information in Section B is incomplete. Applicants who live independently and will cover their own educational expenses should fill out this section themselves in its entirety.

Annual Income:

List sources of income:

Average Monthly Rent Expense:

Average Monthly Utility Expense:

Average Monthly Car Payment Expense:

Average Monthly Insurance Expense:

Average Monthly Food Expense:

Average Monthly Incidentals Expense:

List all scholarships and/or financial aid applied for, noting if they have been approved, or not.

For applicants who live at home, parents/guardians should fill out this section in its entirety.

Annual Gross Household Income:

Do you own your own home?

If YES, what is the value of your home's equity?

(Market value, minus the mortgage balance)

List all outstanding debts over $1,000:

Press the + sign on the right of the field to add more lines.

Will applicant contribute to his/her post-secondary expenses?

If YES, in what way?

Describe any specific information currently influencing your family’s financial need in meeting the applicant’s post-secondary educational costs (i.e. medical bills, loss of job, family illness, etc.):

School GPA/SAT/ACT

Please fill out this section and attach an official transcript (signed by a school official)

Grade Point Average (unweighted, based on a 4.0 scale)

Applicant's Highest SAT/ACT Scores

Transcript Attached?

Yes

File

Max. file size: 8 MB.

Applicant Name

Applicant Name Entered Represents Signature That Above Is True

Parent Name

(If Applicable) Name Entered Represents Signature That Above Is True