Kim Rogers Graves Can-Do Education Assistance Application

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Completion of this application gives Literacy KC permission to perform a criminal background check as necessary

Personal Information

Date:

Salutation

First Name:

M.I.

Last Name:

Address:

City:

State:

Zip Code:

Phone Number:

Phone Type:

Email:

Educational Level/Degree:

Gender:

Race/Ethnicity:

Date of Birth:

Employer:

Occupation:

Request

Amount being requested:

Date needed by:

Where does the payment need to be sent?

Additional Information:

When did you attend Literacy KC:

How long did you attend Literacy KC:

What did you accomplish at Literacy KC:

Hours of study completed at Literacy KC:

Focus of study at Literacy KC:

How did you hear about the Can-Do Grant for Educational Assistance?

Are you currently receiving or applying for other grants/scholarships or financial assistance?

Please describe below:

Do you have relevant skills, expertise, or experience you would like to share with Literacy KC to consider during the decision-making process (i.e. previous education or certification or experience)?

Are you a member of any community organizations? i.e.. church involvement, volunteering at a local non-profit, etc.

Please list them below:

Please include any comments or special considerations you would like the advisory committee to consider.

Please indicate how this grant will be used if awarded.

Working towards Associates DegreeWorking towards Bachelor's DegreeObtain a certification

Field of Study?

Educational Institution?

Certification Field?

Certification Program?

Are you applying for any additional supplemental support? (i.e. tools, scrubs, or other supplies required for education)

Please explain the need and cost below.

Please write a short essay:

a. Expressing personally why you are pursuing continued education.

b. Expressing how studying at Literacy KC has affected your life.

c. Expressing how this grant will help achieve your goals.

Scholarships will be awarded to individuals and disbursed directly to the educational institution in August and January.

Applications are accepted year-round however formal announcements will be made in April and November of each year.

Students may reapply annually up to four years if the student is making progress towards earning a degree or certification. Progress towards earning a degree includes: a minimum of 6 credit hours per semester or its equivalent, passing classes, being in good standing with the educational institution, not dropping out, and other criteria as determined by the Advisory Committee. Progress towards earning a certification will be determined on an individual basis by the Advisory Committee.

Award Amount
Varies

Deadline
Spring - December 1st
Summer - April 1st
Fall - August 1st

Please attach the following documents:

1. Copy or photo of identification, must include one of the following:
- Drivers' License
- State Issued ID
- Social Security Card
- Birth Certificate

2. Acceptance letter to the program of your choice and a breakdown of tuition/cost.

3. Breakdown of any supplemental support requested (cost and explanation of need).

4. Photo of applicant:

ALL MATERIALS MUST BE RECEIVED BY THE DEADLINE FOR CONSIDERATION.

All the information on this form is true and complete to the best of my knowledge. I understand that any false statements made by me on this application, or any supplement materials may be grounds for rejection of my application or dismissal from any subsequent funding. Completion of this application gives Literacy KC permission to perform a criminal background check as necessary. If awarded a grant from Literacy KC I agree to share my story and photo as requested to help promote the program to others.

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