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 for consideration during my scholarship selection process.

†††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††† (college/university)

 

Name of Student: _______________________________†† Social Security #: ____/_____/____†† Phone: _____________________

Address: ____________________________________________________________________________________________________ ________________________________________________________________________

†††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††† ††††††††††††††††††††††††††††††††††††††††††††††††††††††††††† (Street)†† ††††††††††††††††††††††††††††††††††††††††††††††††††††( City )†††††††††††††††††††††††††††††††††††††††††††††††† (State)†††††††††††††††††††††††††††††††††† (ZIP) †††††††††††††††††††††††††††††††††(e-mail address)

 

Student or Parentís 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. 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 3, 2018.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:

 

2018/2019 Tuition Costs†††††††††††††††††††††††††††††††††† $ __________________

2018/2019 Room & Board Costs†††††††††††††††††††† $ __________________

Additional Fees††††††††††††††††††††††††††††††††††††††††††††††††† $ __________________

Total††† ††††††††††††††††††††††††††††††††††††††††††††††††††††††††††† $___________________

Parent Contribution††††††††††††††††††††††††††††††††††††††††††† $ ___________________

Student Contribution††††††††††††††††††††††††††††††††††††††††† $ ___________________

Total Calculated need for 2018/2019†††††††††††††† $ ___________________

This student was evaluated as ______________ a dependent ________________††††††††††††† an independent student†††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††† Studentís School ID# ________________________________________( if needed to request further financial information on unconfirmed grants)

(continued on other side)

To the Financial Aid Office:Information for the 2018-19 academic year should reflect the aid package offered to the student

Coming Year 2018, 2019 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 2018/2019†††††††††† $ ________________________

The Hilda E. Bretzlaff Foundationís 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 studentís scholarship is to be mailed††††††††††† ®

Thank you again for your help in this process!!!

††††††††††††††††††††††††††††††††††† To return to Form page click button to the right††††††††††