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College Financial Assistance Application
Application
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* Indicates required question
Email
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Your email
First Name
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Your answer
Last Name
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Your answer
Home Street Address
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Your answer
Home City
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Your answer
Home State
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Your answer
Home Zip
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Your answer
Home Phone
Your answer
Personal Cell
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Your answer
Email
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Your answer
School ID #
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Your answer
Gender Identity
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Male
Female
Other:
Nationality
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Your answer
Undergraduate Status
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Freshman
Sophomore
Junior
Senior
GPA
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Your answer
Please provide the name of the parent or guardian who is currently undergoing or has
recently undergone cancer treatment within the past 12 months:
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Your answer
Relationship to Applicant
Mother
Father
Legal guardian
Clear selection
Type of Cancer
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Breast
Colon
Pancreatic
Other:
Statement of Purpose
I am applying for financial assistance toward college. I understand that I will not personally receive any funds, and that all disbursements will be made directly to my school by The Phoenixx Phoundation, Inc., in support of my educational needs.
Please Initial
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Your answer
Biographical Personal Statement
Please provide a personal statement about yourself
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Your answer
Scholarship Essay.
Please tell The Phoenixx Phoundation why you should receive the Financial Assistance.
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Your answer
Application Checklist
Please include the following documents with your application:
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Current transcript showing full-time student status and a GPA of 3.0+
Two recommendation letters from Professors and one from your Academic Advisor
Doctor’s statement confirming the guardian’s diagnosis (including patient’s name and diagnosis
Personal essay describing how financial assistance will impact your college experience and future goals
Face to face Interview with selected board members (in person, if possible, otherwise via Zoom)
Required
Agreement and Certification
By submitting this application, I certify that all provided information is accurate and complete. I
understand that this application and all related documents will be treated confidentially for
institutional use only. If awarded financial assistance, I agree to the following provisions:
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I will submit an Impact Letter detailing how The Phoenixx Phoundation’s support has influenced my educational goals.
I understand that I must reapply and submit necessary documents annually to be eligible for continued assistance.
I acknowledge that receiving assistance one time does not guarantee future awards.
I agree to provide a video statement by February 1 of the following year, which may be published on The Phoenixx Phoundation’s website and other platforms.
I grant permission for my name and photos to be used in print or digital publications of The Phoenixx Phoundation.
I, along with a parent/guardian, will attend the Presentation Ceremony (date to be determined), to be held in early December. Non-attendance will render me in default of this agreement.
Required
Failure to comply with any provision may result in the requirement to return all funds and ineligibility to reapply for three consecutive semesters.
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Print Applicant First Name
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Your answer
Print Applicant Last Name
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Your answer
Signature
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Your answer
Date
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MM
/
DD
/
YYYY
A copy of your responses will be emailed to the address you provided.
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