Thank you for your interest in a CollegeBound Foundation Last Dollar Grant!

The Last Dollar Grant is a need-based award for Baltimore City public high school graduates whose expected family contribution and financial aid package total less than the cost to attend college. Students who are awarded a CollegeBound Foundation Last Dollar Grant are eligible to receive a grant up to $3,000 per year, renewable for up to five (5) years of college or the maximum amount of $15,000. This money is gift money which does not have to be repaid.

Eligibility:

• Must be a 2010 graduate of a Baltimore City public high school. If you are a returning scholar, please contact CollegeBound at 410-783-2905 (Returning scholars do not need to fill out this form).
• Demonstrate need. Family income must not exceed $75,000 annually. If unmet need is greater than $5,000, student must provide documentation detailing how the gap will be financed.
• Student must contribute at least 15% of college cost through self-help (student loans and/or work study).
• Be accepted to attend a four-year Maryland public or private college.
• You MUST attend the Transition to College Workshop and the Annual Scholars' Luncheon.
• You also MUST attend any other retention program events scheduled throughout the year.

Last Dollar Grant applications must be received by March 1, 2010.

Last Dollar Grant supporting materials must be received by July 1, 2010.

*Required fields

STUDENT INFORMATION

* Social Security: [xxx-xx-xxxx]
* First Name:
* Last Name:
Middle Initial:
* Gender:	Male Female
Race:	-- White Black or African American American Indian or Alaska Native Asian Native Hawaiian or Other Pacific Islander Hispanic Other
* Birth Date: [mm/dd/yyyy]
* Home Address:
* City:
* State:	-- Alabama District of Columbia Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
* Zip Code:
Home Phone:
Cell Phone:
* Email:
NOTE: If you do not have an email address, you may visit www.yahoo.com or www.msn.com to sign up for a free email account.
Name of CollegeBound Specialist/Guidance Counselor:
* Baltimore City Public High School:	-- Academy for College & Career Exploration High School Achievement Academy at Harbor City High School Augusta Fells Savage Institute of Visual Arts Baltimore City College High School Baltimore Freedom Academy Baltimore Polytechnic Institute High School Baltimore School for the Arts High School Baltimore Talent Development High School Carver Vocational-Technical High School Coppin Academy High School Digital Harbor High School Doris M. Johnson High School Edmondson-Westside High School Forest Park High School Frederick Douglass High School Heritage High School Institute of Business and Entrepreneurship High School Maritime Industries Academy Mergenthaler Vocational-Technical High School National Academy Foundation High School New Era Academy New Hope Academy Northwestern High School Patterson High School Paul Laurence Dunbar High School Reginald F. Lewis High School Renaissance Academy High School Southside Academy Vivien T. Thomas Medical Arts Academy WEB Dubois High School Western High School
* Year of Graduation: [YYYY]

ADMISSIONS TEST INFORMATION

SAT score
Highest Critical Reading:
Highest Math:
Writing:
Combined:
ACT Score:
Writing Score:

PARENT INFORMATION

Name of:	Mother Stepmother Guardian/other none
First Name:
Last Name:
Daytime Phone:
Cell Phone:
Email:
Highest Grade Level she completed (please select one):	-- Middle/Junior High High School Some College College Degree Graduate/Professional Degree N/A
Place of Employment:
Annual Income level (please select one):	-- Less Than $25,000 $25,000 - $50,000 $50,000 - $75,000 $75,000 - $100,000 $100,000 or greater N/A
Name of:	Father Stepfather Guardian/other none
First Name:
Last Name:
Daytime Phone:
Cell Phone:
Email:
Highest Grade Level he completed (please select one):	-- Middle/Junior High High School Some College College Degree Graduate/Professional Degree N/A
Place of Employment:
Annual Income level (please select one):	-- Less Than $25,000 $25,000 - $50,000 $50,000 - $75,000 $75,000 - $100,000 $100,000 or greater N/A

Parent(s)/Guardians(s): Ask your Benefits Coordinator if your organization offers tuition assistance such as scholarships, grants and/or education cost reimbursement for children of employees.

COLLEGE INFORMATION

Note: In order to be eligible for a Last Dollar Grant, you must attend a four-year Maryland public or private college.

What is your intended major?
What colleges have you applied to?
* 1st Choice:
Accepted?:	Yes No Pending
Where will you live?:	-- On Campus Off Campus At Home
2nd Choice:
Accepted?:	Yes No Pending
Where will you live?:	-- On Campus Off Campus At Home
3rd Choice:
Accepted?:	Yes No Pending
Where will you live?:	-- On Campus Off Campus At Home