JVS Scholarship Application

Thank you for your interest in the JVS Scholarship Program!

Please fill out the following information.

Note: You may fill out this form electronically. If you are not able to fill out the form electronically, you may print and fill it out. However, please note that we prefer the electronic format. If you need access to a computer

to fill out this form, please contact Raza Handan at rhandan@jvs.org.

Date: _____/_____/_____

Last Name First Name

Street Number Street Name Apt #

City Zip Code

Phone (home) Phone (cell)

E-mail Address

What is your date of birth (mm-dd-yyyy) -

1. Are you currently a JVS client? Yes No

If yes, who is your JVS employment specialist? _____________________________________________

2. Where did you find out about the JVS scholarship program?

Public agency (e.g., EDD, Onestop, Human Services Agency, Dept. of Rehabilitation) (specify) ________________________________________

School (e.g., City College, SFUSD, community college) (specify)

______________________________________________

Community event (e.g., job fair, street fair) (specify) ________________________________________

Jewish organization (e.g., Jewish Family and Children’s Services, synagogue, JCC)

(specify) ________________________________

Other social service agency or community organization (e.g., Goodwill, Toolworks, CVE)

(specify) ___________________________________

JVS (website, internet, staff) (specify) __________________________________

Employer (specify) ________________________________________

Media (newspaper, internet, radio) (specify) _______________________________________

Friend/family member/co-worker Other (specify) _______________________________________

3. What is your religion? __________________________________________________________________________________

4. Are you authorized to work in the US? Yes No

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Initials:______________ Date: _____________

Section A: Career Goal

CAREER GOALS

1. Please describe your career goal. How is this goal a fit for you? What are the current and long-term

prospects for you in this career field?

2. Have you already started looking for work in this field? Yes No

If yes, how long have you been looking? ______________________________________

3. What type of job/job title(s) are you currently interested in? (Please specify up to three titles

actively used by employers in your target field).

Note: You should refer to www.onetonline.org to obtain the O*NET description. The O*NET description might vary slightly from the job titles employers or training providers use. Please select the closest match.

Section A continued on page 3

Occupational Title:

__________________________________

__________________________________

__________________________________

O*NET Description

_________________________________

_________________________________

_________________________________

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Initials:______________ Date: _____________

Section A: Career Goal

4. Which of the following categories best describes the type of employment industry you are

currently interested in? (Check one)

Finance and Business Tech

Office High-level:

Sales:

Hospitality Non-profit/Education

Office Entry, Mid-level:

Healthcare

5. What skills and experience do you have that makes you competitive for the industry and job you are

looking for? (Describe)

7. Please attach to this application up to five job postings related to your target job.

Tip: Target job postings that highlight the need for the training program you are pursuing.

8. Do you intend to seek employment concurrently with or immediately upon completion of your

training? Yes No

Please proceed to Section B: Training Plan

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Initials:______________ Date: _____________

Section B: Training Plan

1. Please provide the following information about your proposed training program:

Course of Study

Degree/Certification Earned at Training Completion

Name of Training Provider/School

Training Provider/School Location

Cost of Training Program

Start Date/End Date

Back-up Start Date/End Date (optional)

Back-up Training Provider/School (optional)

2. Please describe the connection between your training program and your job goal. Is the training a

prerequisite to obtaining the job? If the training is not a prerequisite, please describe why this training

program would position you better as a job seeker.

Section B continued on page 5

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Initials:______________ Date: _____________

Section B: Training Plan

3. Will you be required to pass a certification exam after the training program to be eligible for work?

Yes No

4. Please attach a school/program brochure or any other form of information that speaks to the qualifications

of the training provider (you may also copy and paste information into an electronic document).

Please proceed to Section C: Employment and Education Background

3a. When will you take the exam? ____________________________________________________________________________________________________________________________________________________________

3b. Is the cost of the exam included in the cost of the training program?

If no, how will you cover the cost of the exam?

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

3c. Is there any other information you would like to provide regarding the certification exam?

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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Initials:______________ Date: _____________

Section C: Employment and Education Background

1. Please attach a current and targeted resume to this application.

2. Please provide the following information about your employment history (start with the most recent job).

Name of employer

Job Title Location Dates employed Supervisor

3. Which of the following best describes your high school, college or graduate school education

level? (Check only the highest level)

High school/

GED classes.

Never attended

Stopped attending

Currently enrolled/attending

Graduated/completed

Diploma

GED

Country of Issue (leave blank if United States)

College (including community college, state college or university).

Stopped attending

Currently enrolled/attending

Graduated/completed

Associates (AA)

Bachelors’ (BA, BS)

Other (specify)

___________________

Country of Issue (leave blank if United States)

Graduate school.

Stopped attending

Currently enrolled/attending

Graduated/completed

Masters’ (MA, MS, MBA)

Doctorate (PhD, MD, JD)

Other (specify)

___________________

Country of Issue (leave blank if United States)

4. Please provide information about your trade/technical school education if applicable:

Trade/technical school (e.g., computer, automotive, electrical, cosmetology).

Stopped attending

Currently enrolled/attending

Graduated/completed

specify field of study__________

__________________________

__________________________

Section C continued on page 7

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Initials:______________ Date: _____________

Section C: Employment and Education Background

5. Please provide information about any occupational certifications and/or licenses you have?

Type of Certificate/License Issue Date

Expiration Date (write N/A if not

applicable)

Was this issued in the United States?

Yes - US No-not US

Yes - US No-not US

Yes - US No-not US

Yes - US No-not US

Please proceed to Section D: Financial Need

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Initials:______________ Date: ____________

Section D: Financial Need

1. What is your employment status: Employed Unemployed Under-employed

Notes:

2. What is the source of your monthly income?

Part-time Employment Savings

Full-time Employment School Scholarship

CALM (Cash Assistance Linked to Medi-Cal) SDI (State Disability Insurance)

CAPI (Cash Assistance Program for Immigrants) SSA (Social Security Administration – Retirement)

Child Support SSDI (Social Security Disability Insurance)

Family Resources SSI (Supplemental Security)

Financial Aid/Grant for School SSIP (Supplemental Security Income Pending)

Food Stamps TANF/Calworks

GA (General Assistance) Training Stipend

Income of Spouse/Partner Unemployment Benefits

JFCS Financial Assistance Veteran’s Benefits

PAES (Personal Assisted Employment Services) Worker’s Comp

RCA (Refugee Cash Assistance) Don't Know

Retirement/Pension Other: ______________________________________

3. Do you have any dependent family members? Yes No

If yes, how many dependent family members do you have? _______________

4. Please indicate the members of your household:

Spouse

Children (how many? _______________)

Parents (how many? ________________)

Other (please explain: ___________________________________)

Notes:

Section D continued on page 9

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Initials:______________ Date: ____________

Section D: Financial Need

5. Do you have any outstanding loan obligations? Yes No

If yes, please indicate the source and amount: _____________________________________

6. Gross Income for Family

Household Member

Source of Income

Hrs/ Week*

$/Hr* Monthly Gross** Income

Previous Year’s Income

Applicant -- $ $ $

-- $ $

Spouse -- $ $ $

-- $ $

Child -- $ $ $

-- $ $

Child -- $ $ $

-- $ $

Parent -- $ $ $

-- $ $

Parent -- $ $ $

-- $ $

Other: -- $ $ $

-- $ $ $

Total $ $

*When applicable **Before taxes

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Section D continued on page 9

Initials:______________ Date: ____________

Section D: Financial Need

1. Household Budget Summary: Estimated expenses and income for the time period for which grant is

being requested

Period of Time: From to Number of Months:

EXPENSES

Description Comments Monthly (when applicable)

Total Amount

Tuition $ $

Fees $ $

Books $ $

Study Transportation $ $

Family Transportation $ $

Rent $ $

Utilities $ $

Food & Personal $ $

Clothing $ $

Medical $ $

Loan Payments $ $

Other: $ $

Other: $ $

Total Expenses: $

INCOME

Description Comments Monthly (when applicable)

Total Amount

Student Savings: $ $

Anticipated Net Job Earnings $ $

Public Assistance: $ $

GA/RCA $ $

AFDC $ $

MBG $ $

SSI $ $

Food Stamps $ $

Family Contribution: $ $

Other (e.g. spouse income): $ $

$ $

Subtotal Income: $

Scholarship Grants: $ $

Name: Pending Approved $ $

Scholarship Loans $ $

Name: Pending Approved $ $

Total Income: $

2. Difference between income and expenses: $

3. Amount requested from JVS: $

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Initials:______________ Date: ____________

Section E: Statement of Purpose

Thank you for providing the above information. The Scholarship Committee weighs a variety of factors when determining who will most benefit from the scholarship funds available. These factors include:

the marketability of your job goal

your competitiveness for the job goal

the training program must be vocational

the training must be short term, or at least be used for the end of a longer-term training program

the strength of the vocational training program

the connection between the vocational training and job prospects

your financial need

your likelihood of completing the training and obtaining work soon thereafter

With these factors in mind, please provide a statement of no more than 500 words that addresses your fit for this program based on the above information. You may use the space below, or attach in a separate document.

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Initials:______________ Date: ____________

Section E: Statement of Purpose

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Initials:______________ Date: ____________

Section F: Final Checklist

The following items are required to submit a complete application (please check below if complete):

Section A: Career Goals

Section B: Training Plan

Section C: Employment and Education Background

Section D: Financial Need

Section E: Statement of Purpose

Attach up to 5 Job Postings (on paper or copied into an electronic document)

Attach a current and targeted resume

Attach information about the school and program of study (e.g. brochure, copy and paste information from the website in an electronic document, etc).

Signature (below)

Please note that the scholarship application must be completely filled out to be considered by the committee. I hereby affirm that the information I provided on this application is complete and accurate. I understand that any falsification can be grounds for immediate rejection of my application. __________________________________________________________________________________________ Print Name Signature Date

Thank you for your application to the JVS Scholarship Program!

If you have any further questions about your application, please contact Raza

Handan at rhandan@jvs.org, or (415) 782-6263.