Edythe Hayden Friley & Grant A. Friley Fund Application

Please provide all information requested. Type directly into this form.

SECTION 1: APPLICANT INFORMATION

First name:*

Middle name:*

Last name:*

Current address:*

City:*

State:*

Zip code:*

County:*

Email:*

Home phone:

Cell phone:

Please provide Name and Location (City, State) of Institution where you were incarcerated. *

Please provide the dates of your prison sentence:*

Please provide your inmate number (if applicable):

Do you intend to use funds for academic advancement or housing?*

Yes

If applicable, please provide the name and location of the accredited educational institution where you are currently attending or plan to attend?

What are you majoring in, or plan to major in?

Alternatively, please provide the name and location (city and state) of the housing site where you seek to move or continue living.

Please provide the name, address, title, telephone number and email of the rental office of the housing site where you seek to move or continue living.

Name Of Housing Site

Email address Of Housing Site

Phone Of Housing Site

Address Of Housing Site

SECTION 2: PERSONAL STATEMENT

Provide a brief written response (no more than 1-2 pages) or a 5-minute video responding to the following questions:

Tell us about your personal background, passions and interests.
What steps have you taken to further your personal and professional development since release from prison.
How do you plan to use your scholarship?
If you receive this scholarship, what is the impact you want to have?
Is there any particular financial need or personal hardship or experience that you have faced/are facing that we should be aware of?

Upload*

SECTION 3: SUPPLEMENTAL MATERIALS

If seeking funds for housing: (i) copy of lease for housing site; and (ii) correspondence on letter head, signed by owner or manager, evidencing your residency at the housing site.
If seeking funds for academic advancement: (i) copy of transcript from institution where student attends; (ii) copy of acceptance letter from institution; and (iii) letter of recommendation from counselor or professor.

Upload*

SECTION 4: VERIFICATION

I attest that everything that I have submitted is accurate and true to the best of my knowledge.

Name

First

Last

Date

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