Thank you for your interest in the Wilhelmina Holder Student Assistance Fund. Please complete this application fully and attach any proof of your current need. Applications are accepted on a rolling basis and awards will be distributed quarterly (January, May, August, November) or monthly for emergencies. *Emergency Applications will be reviewed every 2nd Friday of the month. If there is an urgent need, email wholderefund@gmail.com after submitting.
Background/Demographic Info.

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* 1. Name:

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* 2. Are you a resident of Essex County or Greater Newark area? (If not, please do not complete this application)

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* 3. Date of Birth:

Date

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* 4. Email Address:

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* 5. Home Address:

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* 6. Phone Number:

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* 7. Gender (select one):

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* 8. Race:

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* 9. Emergency Contact Name:

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* 10. Emergency Contact Number:

School/Program Information

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* 11. Required: Post-Secondary School/Program Name:

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* 12. Type of School/Program you are enrolled in (select one):

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* 13. Grade Level:

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* 14. Current Major/Field of Interest:

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* 15. Current GPA:

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* 16. Are you currently on Academic Probation?

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* 17. If yes, what plan do you have in place to improve your academics?

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* 18. What is your dream for your future? How will receiving this degree or certificate impact your life? (Minimum 100 words, Maximum 250 words)

Demonstrated Need: Emergency Fund Request
We want to understand your current challenges and the supports available to you. Please answer the following questions to the best of your ability to help us better understand the context of your current situation.

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* 19. Please indicate who referred you to the fund (select one):

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* 20. Specify the exact amount of Emergency Funds Requested ($) (must have documentation to support)

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* 21. Describe the current circumstance or challenge that brought on the emergency need for these additional funds. Please include details. Must attach proof of the need. (i.e., a bill, court order, payment plan, etc.) (Minimum 100 words, Maximum 250 words

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* 22. Attachment: Include any attachments that demonstrate your request. Must include: 1. Proof of enrollment. 2. Bill/Account Summary for request 3.Any other document showing proof of emergency need.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
Choose File

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* 23. Is this an emergency that requires money immediately (14 days or less)?
*Emergency Applications will be reviewed every 2nd Friday of the month. If there is an urgent need, email wholderefund@gmail.com after submitting.

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* 24. Please describe what steps to resolve this current need. (For example -  met with the financial aid office, requesting a payment plan, reaching out to family/friends, and job search) (Maximum 250 words)

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* 25. Do you anticipate having this challenge again? If so, please explain.  (Maximum 250 words)

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* 26. How will these funds help you to successfully complete your school program and obtain your degree or certificate? (Minimum 100 words, maximum 250 words)

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* 27. I certify that in the information contained within this application is accurate to the best of my knowledge. If selected, I consent to the Wilhelmina Holder Fund Board use of my information or image for the purposes of contacting me or promoting the Fund's commitment to educational excellence and advocacy.

Thank you for applying for the Wilhelmina Holder Student Assistance Fund! Awards are announced by February 1st, June 1st, September 1st and November 1st.  If you indicated that this is an emergency request, we will be in contact with you within 30 days. Students who apply by August 5, 2023 will be invited to participate in a special Kick-off event in August 2023 in honor of Ms. Holder. 

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