Memorial Fund Scholarship Application

Name of Deceased Fisherman Year of Death Name of Vessel Name of Applicant Permanent Address of Applicant Social Security Number Date of Birth Phone Number for Contact Email State of Residence Your relationship to the Deceased What is your marital status? Are you currently attending school Were you claimed as a dependent on the deceased fisherman's 1040 form in the year of death? In the precending year? Would you be dependent on the deceased fisherman today? What educational institution(s) do you plan to attend in 2021-2022? Please enter name followed by address for each institution. What courses of study do you plan to pursue? Do you plan to attend on a full time basis? What are the annual expense for tuition? What are the annual expense for housing? What are the annual expense for board? What are the annual expense for books? Do you plan on living at home while attending the institution? What do you believe your educational financial needs will be for 2021-2022 What degree or certification do you expect to receive (if any)? Have you applied for this scholarship before? What other types of financial aid are you (and your parents) receiving toward your educational plans? What is the number of persons in your household? Please include yourself, spouse, and dependent children if any. 1 2 3 4 5 6 7 8 9 10 More than 10 What is the number of college students of the household in 2021-2022 If you and or your family have any other unusual circumstances that affect the household's ability to provide you with financial assistance or your eligibility for financial aid through other sources. Do you have any education benefits available from trusts, insurance settlements, Cloverdale educationals accounts, Section 529 education savings plans or any other source? Total number of exemptions claimed in 2020 Adjusted Gross income in 2020 US income tax paid in 2020 Earned income credit in 2020 Untaxed Social Security Benefits 2020 AFCE/ADC or TANF Benefits in 2020 Child support received for all children in 2020 Other untaxed income and benefits in 2020 What is your cash balance What is your current balance in all savings accounts What is your current balance in all checking accounts What is the current value of other real estate and investments (not including the family home) What is the current balance of other real estate and investments debt Business value Business debt