Scholarship Submission Form

Scholarship Foundation Application - Albany Housing Authority

The Albany Housing Authority has established an annual scholarship. This scholarship will assist students with the financial expenses of pursuing higher education.

SELECTION CRITERIA

1. The applicant must be a tenant/resident residing in rental property owned, affiliated with, or subsidized by the Albany Housing Authority. All applications will be verified with applicable tenant records and should be in good standing.

2. The applicant must be a senior in high school, (OR) a presently enrolled college student, (OR) a re-entry student pursuing academic, technical or vocational training. The applicant must be accepted at an accredited academic, technical or vocational Institute.

3. The applicant must have a 2.5 or higher cumulative grade point average. (May be waived for re-entry/GED student – out of school for at least five (5) years).

4. The applicant must submit a completed legible application.

5. The applicant cannot have won 1st, 2nd, or 3rd prize in the AHA Scholarship within the last 2 years to be eligible.

6. All disbursements of winnings will be issued directly to the respective college, technical institute, or vocational training school. Checks will not be made directly to the applicant.

Three scholarships for the 2024 Fall Quarter or Semester will be awarded in the amounts of: 1st Prize-$3,000.00, 2nd Prize-$2,000.00, and 3rd Prize-$1,000.00

Deadline – July 19th, 2024

1. APPLICANT NAME:*
First Last
2. Last Four (4) Digits of SSN:*
3. HEAD OF HOUSEHOLD:*
First Last
4. Last Four (4) Digits of SSN:*
5. APPLICANT’S RELATIONSHIP TO HEAD OF HOUSEHOLD:*
6. (Please Check One)*
- Section 8
- AHA Resident
- Both
7. MAILING ADDRESS:*
Street Address Address Line 2 City State ZIP Code
8. PHONE NUMBER:*
Cell Home Work
9. EMAIL:*
10. CURRENT NAME OF HIGH SCHOOL, COLLEGE OR TECHNICAL/VOCATIONAL SCHOOL:*
CURRENT ADDRESS OF HIGH SCHOOL, COLLEGE OR TECHNICAL/VOCATIONAL SCHOOL:*
Street Address Address Line 2 City State ZIP Code
11. ANTICIPATED GRADUATION YEAR (IF APPLICABLE):*
12. AREA OF STUDY/MAJOR:*
13. COLLEGE, UNIVERSITY OR TECHNICAL/VOCATIONAL SCHOOL OF PLANNED ATTENDANCE (NAME):*
COLLEGE, UNIVERSITY OR TECHNICAL/VOCATIONAL SCHOOL OF PLANNED ATTENDANCE (ADDRESS):*
Street Address Address Line 2 City State ZIP Code
HAVE YOU BEEN ACCEPTED?*
14. LIST EMPLOYMENT HISTORY (INCLUDE VOLUNTEER AND COMMUNITY WORK):*
Employer, Volunteer & Community Work Address Phone Number Period Worked
I DECLARE THAT I HAVE READ AND UNDERSTAND ALL THE INSTRUCTIONS ON THE PRECEDING PAGE. I HEREBY DECLARE THE INFORMATION PROVIDED IS TO THE BEST OF MY KNOWLEDGE AND ANY MISREPRESENTATION MAY CAUSE MY SCHOLARSHIP APPLICATION TO BE DISQUALIFIED FOR CONSIDERATION.
*
NAME OF APPLICANT DATE
EDUCATION EXPENSES & FUNDING SOURCES WORKSHEET
1. Please itemize the costs of educational expenses for the 2023-2024 school year below (include resources confirmed or anticipated). Also include any other grants, scholarships, loans, or any other financial assistance from other institutions, friends, and/or family members.
a. Cost of Tuition*
b. Anticipated Cost of Books*
c. Cost of Room & Board (if applicable)
d. Any other financial assistance confirmed (provide name of source):
Name Amount
e. Any other financial assistance anticipated:
Name Amount
Total Anticipated 2023-2024 School Expenses:*
Essay*
2. Please share a personal statement about significant experiences, community involvement, and the qualities of character and leadership important to achieving your goals. Highlight personal accomplishments, achievements, experiences and life circumstances that have helped form your character. Explain how you see the college education or vocational training improving your quality of life, and the impact receiving a scholarship would have on your life, educational, and career goals. Please type your statement and attach to application. Keep your statement under 1,000 words. (Submitted File Uploads must be in PDF, doc, docx or odt format and less than 18MB in size)
Accepted file types: pdf, doc, docx, odt, Max. file size: 18 MB.
Letter of Reference*
3. A "Letter of Reference" (from employer, teacher, instructor, clergy, etc.). It cannot be from a household family member. Please be advised this letter must be under 1,000 words.
(Submitted File Uploads must be in PDF, doc, docx or odt format and less than 18MB in size)
Accepted file types: pdf, doc, docx, odt, Max. file size: 18 MB.
MEDIA AUTHORIZATION AND RELEASE FORM*
I hereby assign to the Albany Housing Authority Scholarship for its exclusive use for public relations or communications materials, all photographs, motion pictures, video tapes, and/or audio recordings taken or made in the production of brochures, flyers, films and radio spots at any time, and without limitation(s), except as set forth below on this form. I hereby authorize the Albany Housing Authority Scholarship to reproduce, copy, exhibit, publish or distribute any and all such photographs, motion pictures, video tapes, and/or audio tapes in connection with business operations purposes. I agree to hold harmless Albany Housing Authority and the Albany Housing Authority Scholarship, its commissioners, officers, agents and employees from any claim, liability, loss, injury or damage arising out of, or in connection with, any publication and distribution of photographs, motion pictures, video and audio recordings of my myself and of my Application Essay in connection with publicity and public relations relating to Albany Housing Authority and the Albany Housing Authority Scholarship program. I understand that the determination of the Finalists and the Winning Essays and the award of Prizes is within the sole and absolute discretion of Albany Housing Authority Scholarship Committee and that their evaluations and decisions are final. I understand and agree that I have not, and will not, receive any compensation for the Albany Housing Authority Scholarship’s use of the materials and information described herein. All applications will be considered regardless of consent to release information. Please select one:
- Yes. I do give consent to release information.
- No. I do not give consent to release information.
Print Name*

Digital Signature (Parent/Legal Guardian must sign if release is for a minor – under age 18)
Print Name of Witness

Digital Signature (Only if applicant is a minor)
By submitting this application I affirm that the information which I have provided on this application form and any additional material that I submitted related to the financial aid is complete, accurate, and true to the best of my knowledge. Pursuant to the Family Educational Rights and Privacy Act of 1974, as amended (FERPA), I hereby authorize the Albany Housing Authority Scholarship to release the scholarship application information provided by me, as well as other official and unofficial documentation regarding my academic information, status, and financial need, to the Albany Housing Authority Scholarship Committee for the purpose of providing the committee with information concerning my eligibility as a scholarship recipient. I also understand that furnishing false information may result in revocation of my application.*
Signature (Parent/Legal Guardian must sign if under age 18) Signature of Witness (Only if applicant is a minor)
Date*
MM slash DD slash YYYY

Employer, Volunteer & Community Work	Address	Phone Number	Period Worked

Cell	Home	Work

Name	Amount

Name	Amount

Scholarship Submission Form

Scholarship Foundation Application - Albany Housing Authority

I DECLARE THAT I HAVE READ AND UNDERSTAND ALL THE INSTRUCTIONS ON THE PRECEDING PAGE. I HEREBY DECLARE THE INFORMATION PROVIDED IS TO THE BEST OF MY KNOWLEDGE AND ANY MISREPRESENTATION MAY CAUSE MY SCHOLARSHIP APPLICATION TO BE DISQUALIFIED FOR CONSIDERATION.

EDUCATION EXPENSES & FUNDING SOURCES WORKSHEET

1. Please itemize the costs of educational expenses for the 2023-2024 school year below (include resources confirmed or anticipated). Also include any other grants, scholarships, loans, or any other financial assistance from other institutions, friends, and/or family members.

Albany Housing Authority