APPLICANTS ARE TO COMPLETE THE TOP SECTION AND THEN SEND THIS FORM TO THE FINANCIAL AID OFFICE OF THE SCHOOL THEY WILL BE ATTENDING!!!!!
HILDA E. BRETZLAFF FOUNDATION, INC.
1550 N. Milford Road, Suite 101, Milford MI 48381
To Be Completed by Applicant:
I authorize _______________________ to release the information requested below to the Hilda E. Bretzlaff Foundation
(college/university)
for consideration during my scholarship selection process.
Name of Student: _______________________________ Social Security # ____/_____/____ Phone _____________________
Address: _______________________________________________________________________________________________
(Street) (City) (State) (Zip) (e-mail address)
Student or Parent’s Signature: _______________________________ Date: ______________________
To be completed by the Financial Aid Office:
The above named student is applying for a scholarship from the Hilda E. Bretzlaff Foundation. Please complete the information below and return it directly to:
The Hilda E. Bretzlaff Foundation
Attn: Kathleen Lindbeck
1550 N. Milford Rd., Suite 101
Milford, MI 48381
Phone: 248-684-3408 Fax: 248-684-2648
HEBF would like to thank you for your assistance and requests that this form be postmarked or faxed no later than August 5, 2010. If a scholarship is not yet confirmed, you may be contacted to get the award amount at a later date.
Please enter the results of your calculations using the methodology applicable to an external scholarship award:
2010/2011 Tuition Costs $ __________________
2010/2011 Room & Board Costs $ __________________
Additional Fees $ __________________
Total $___________________
Parent Contribution $ ___________________
Student Contribution $ ___________________
Total Calculated need for 2010/2011 $ ___________________
This student was evaluated as ______________ a dependent __________ an independent student
Student’s School ID# ________________ (if needed to request further financial information on unconfirmed grants)
(continued on other side)
To the Financial Aid Office: Information for the 2010-11 academic year should reflect the aid package offered to the student
Coming Year 2010/2011 Package
Other Scholarships/Grants:
Grant Covers
Grant Name Confirmed Amount Tuition & Books Room & Board
_________________________ ¨ _______________ ¨ ¨
_________________________ ¨ _______________ ¨ ¨
_________________________ ¨ _______________ ¨ ¨
_________________________ ¨ _______________ ¨ ¨
_________________________ ¨ _______________ ¨ ¨
Federal Pell Grant ¨ _______________ ¨ ¨
Total Amount of Other Grants/Scholarships $ ______________
Self-Help Aid:
Loans/Work Study Aid: Confirmed Amount
______________________________ ¨ _____________________
______________________________ ¨ _____________________
______________________________ ¨ _____________________
Total Amount Loans/Work Study Aid $ ____________________
UNMET NEED for 2010/2011 $ ________________________
The Hilda E. Bretzlaff Foundation’s intentions are to supplement need for tuition and/or books up to a budgeted amount that the student will have above and beyond his/her other grant amounts. The Self-Help Aid information helps HEBF gain a bigger picture of the amount of need the student has.
Name of Financial Aid Officer Completing this form: __________________________________________________
Title: ______________________________________ Phone: ______________________________________
College/University: _________________________________ E-mail address: ________________________________
Address: __________________________________________________________________________________________
(Street) (City) (State) (Zip)
Please check this box if the above address is where the student’s scholarship is to be mailed ¨
Thank you again for your help in this process!!!