Fillable 2017 AntiochLY Dapplication (Los Medanos College)

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2017 AntiochLY Dapplication (Los Medanos College)

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®
®
powered by volunteers of
®
empowered by activists of
LIVEYOURDREAM.ORG
Since 1972, the Soroptimist Live Your Dream Awards
program (formerly the Women’s Opportunity Awards)
has disbursed more than $30 million to tens of
thousands of women who have overcome poverty,
domestic and sexual violence, divorce, the death of
a spouse, or other life challenges. They are women—
just like you—who had the courage and determination
to turn their lives around.
Most regions grant additional $3,000 awards. The
first-place recipients then become eligible for one
of three $10,000 finalist awards.
Soroptimist also oers awards through its
headquarters oce to applicants who do not live
within the territorial limits of a Soroptimist club.
Each year about $1.7 million is awarded through
the Soroptimist Live Your Dream
Awards program.
eady to begin a new life?
R
Recipients may use the cash award
to oset any costs associated
with their eorts to attain higher
education, including books, childcare
and transportation. The program
begins on the club level, where
award amounts vary. Club recipients
become eligible to receive region-
level awards, which are granted
through Soroptimist’s 28 geographic
regions. Currently, each Soroptimist
region grants one first-place award
for $5,000.
education & training awards for women
YOUR
dream
live
®
®
Antioch Soroptimist - Live Your Dream Awards
$2000
Instructions
Deadline: Applications are due each year by November 15, and are accepted between July 1 and November 15. Award recipients will be
notified between January and June. Not all applicants will be selected for awards. Applications can only be submitted to SIA Headquarters or
one club. Your application will be reviewed by a panel of judges, but all information will remain confidential and will not be shared without your
prior permission.
Step 1: Determine if you are eligible
You are eligible if you are a woman who:
• Provides the primary financial support for yourself and your dependents. Dependents can include children, spouse, partner, siblings and/or parents.
• Has financial need.
• Is enrolled in or has been accepted to a vocational/skills training program or an undergraduate degree program.
• Is motivated to achieve your education and career goals.
• Resides in one of Soroptimist International of the Americas’ member countries/territories (Argentina, Bolivia, Brazil, Canada, Chile, Colombia,
Ecuador, Guam, Japan, Korea, Mexico, Northern Mariana Islands, Panama, Paraguay, Peru, Philippines, Puerto Rico, Taiwan, United States of
America, Venezuela).
• Has not previously been the recipient of a Soroptimist Women’s Opportunity or Live Your Dream Award.
• Does not have a graduate degree.
• Is not a Soroptimist member, an employee of Soroptimist International of the Americas or immediate family of either.
• Has a Social Security number or Tax ID number. (This is required for tax purposes and is only necessary if you are a resident of the United States. You
will not be asked to share this information unless you have been given an award.)
Step 2: Tell us about yourself
Fill out the award application telling us about yourself. Your information will be kept confidential and shared only with the evaluators unless you
give us written permission to use your story to publicize the program. **You must use Adobe Reader—a free download—to fill out the form. If you
do not use Adobe Reader, your answers in the application will not be saved.**
• Step 1: Download Adobe Reader.
• Step 2: Save a copy of the application to your computer.
• Step 3: Open Adobe Reader.
• Step 4: From the left column, choose ‘My Computer’ and find where you saved the application.
• Step 5: Open the application within Adobe Reader.
• Step 6: Hold your mouse over the first blue text box and click.
• Step 7: Type your responses into the application. (Note: You will not be able to change the type size. Please limit your answers to the
space allotted.)
• Step 8: Once all parts of the form are completed, select “File” and choose “Save As” from the drop down menu.
• Step 9: Change the file name (for example, “LYDApplicationLG,” where LG are your initials.)
• Step 10: Click “Save.”
• Step 11: Submit.
Step 3: Ask people to tell us about you
You will need two dierent people—who are not related to you—to fill out the reference forms. It is recommended that you request references
from people who know you from an education or work setting. Please email the form to your references and request they email the form back to
you when completed. Only two references will be accepted. Please use the form and do not submit reference letters.
Step 4: Submit your application
Applications are accepted between July 1 and November 15. Once you have saved your application and reference forms, please visit http://www.
soroptimist.org/rise/SIA/lydapplication to begin the submission process.
Questions
Check out the Live Your Dream Award Frequently Asked Questions at http://www.soroptimist.org/awards/dreamawardsfaqforapplicants.pdf. If you
still have questions, contact Soroptimist headquarters at siahq@soroptimist.org.
Ready to Apply?
Begin your application on the next page now! We wish you the best of luck in achieving your educational and professional goals.
education & training awards for women
YOUR
dream
live
®
Submit your completed application to: Live Dream Award Attn:
Stephanie Helberg/ P.O. Box 2021, Antioch, CA 94531
Part I. Basic Information
Name (first, middle initial, last):
Address (number and street address):
City/Province: State:
Postal Code: Country:
Telephone: Email Address:
Date of Birth: Marital Status:
Highest level of education achieved: Date Completed :
Number of dependents you support (NOT including yourself):
How are they related to you (children, spouse, parents, etc.)?:
Ages (if they are children):
Part II. What are your education and career goals?
A. What’s the name of the school or training program you are attending or have been accepted to?
B. What are you studying? (example: Bachelor of Science nursing degree or computer science certificate)
C. When will you complete your studies (month and year)?
D. Are you working while you are getting your education? (check one) YES NO
If yes, how many hours per week?
E. In 300 words or less, please tell us about your career goals, and give specifics about how your education and training sup-
ports these goals.
Ready, Set, Live Your Dream!
Begin your application now.
Part III. Financial Information
Live Your Dream Award recipients are chosen in part based on financial need. Please share information about your annual income and
expenses. Please be as exact as you can.
A. INCOME: Please list your ANNUAL household income and savings (from the money you have left after taxes) in the chart
below.
B. EXPENSES: Please list your ANNUAL household expenses in the chart below.
Housing: $________________ per year
Food: $________________ per year
Childcare: $________________ per year
Tuition: $________________ per year
Utilities: $________________ per year
Medical: $________________ per year
Transportation: $________________ per year
Books: $________________ per year
Employment: $____________ per year
Savings: $________________ per year
Child Support: $________________ per year
Alimony: $________________ per year
Government Assistance: $____________ per year
Social Security (U.S. only): $________________ per year
Loans: $________________ per year
Scholarships: $________________ per year
Please list any additional income, including income other household members receive.
Source: ______________________________________________________ $__________ per year
Source: ______________________________________________________ $__________ per year
Source: ______________________________________________________ $__________ per year
TOTAL ANNUAL INCOME:
Please list any additional expenses.
Expense: _____________________________________________________________________________ $__________ per year
Expense: _____________________________________________________________________________ $__________ per year
Expense: _____________________________________________________________________________ $__________ per year
TOTAL ANNUAL EXPENSES:
Part IV. Tell us more about yourself
The Live Your Dream Award is all about helping women who have faced economic and personal hardships to live their dreams. Since 1972, the
award has provided tens of thousands of women with cash grants to help them achieve their educational and career goals. The program helps
women build a better life for themselves and their dependents. Do you think this award could help you live your dream? In 750 words or less, tell
us about the challenges you’ve faced and how you think this award could help you to live your dream.
Part V. Agreement
Please read the following information carefully. When you type your name below, you are agreeing to what you have read.
• I certify that all the information provided in this application is complete and accurate to the best of my knowledge. I will notify Soropti-
mist if there are any changes.
• I understand this award is not a scholarship and is therefore taxable for citizens of the United States. (For more information, consult IRS
publication 520. Residents of other countries should check their local tax laws.)
• I certify that this is the only application I have made—in any format or to any address—this year for a Soroptimist Live Your Dream
Award.
• I understand that my application may be submitted electronically for evaluation.
• I understand that my application becomes the property of Soroptimist International of the Americas. The application will be considered
confidential unless the applicant grants Soroptimist written permission to release personal information for the purpose of publicizing
the award.
By typing your name below, you adhere to the above requirements.
Signature of applicant Date
How did you hear about the Soroptimist Live Your Dream Award?
A local Soroptimist club
A friend, relative, or co-worker
A career counselor or advisor at my school
Social media
A flyer posted in my community
Internet search
Torrid Store
Searchable database of scholarships: ___________________________________________________________________________________________
Other: ______________________________________________________________________________________________________________________
Thank you for applying for the
Live Your Dream Award.
Congratulations on all you have achieved so far!
Soroptimist International
of the Americas
1709 Spruce Street
Philadelphia, PA 19103-6103
215-893-9000
www.Soroptimist.org
www.LiveYourDream.org
®
Live Your Dream
Attn:Stephanie Helberg
P.O. Box 2021
Antioch, CA 94531
Questions: Please email stephanie@wavesofspirit.com or call
(925) 876-9442
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2017 AntiochLY Dapplication (Los Medanos College)

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Completed 18 July 2020

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