Fillable 2021 GFWC Success for Survivors Scholarship (New Jersey State Federation of Women's Clubs)

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2021 GFWC Success for Survivors Scholarship (New Jersey State Federation of Women's Clubs)

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2021 GFWC Success for Survivors Scholarship Application 1
2021 GFWC Success for
Survivors Scholarship
The General Federation of Women’s Clubs is a national leader in the ght to end domestic violence. To emphasiz
e our dedication
in tackling this societal issue, GFWC implemented the Success for Survivors Scholarship in 2011.
We award $2,500 scholarships to help survivors of intimate partner violence obtain a post-secondary education that will offer
them the chance to reshape their future by securing employment and gaining personal independence.
Candidates must be enrolled or planning to enroll at an accredited public or private post-secondary school, including commu-
nity colleges, technical schools, and four-year universities. Applicants should check with their school enrollment or nancial aid
oce to conrm accreditation. Applicants also may visit the U.S. Department of Education website at www.ope.ed.gov/accredi-
tation. Scholarships are for post-secondary study only.
ELIGIBILITY
Candidates must meet all of the following eligibility requirements to apply:
• Survived intimate partner violence*;
• Citizen or permanent legal resident of the United States;
• Enrolled or planning to enroll at an accredited public or private post-secondary or vocational institution;
• Recommended by a licensed or accredited domestic violence agency and/or counselor or social worker, willing to provide
information on behalf of the applicant.
*According to the Centers for Disease Control and Prevention, the term intimate partner violence describes physical, sexual, and/or psychological harm
by a
current or former partner or spouse. This type of violence can occur among heterosexual or same-sex couples and does not require sexual intimacy.
2021 GFWC Success for Survivors Scholarship Application 2
RECOMMENDING COUNSELOR/SOCIAL WORKER/AGENCY
The recommending counselor, social worker, or agency must attest to supporting the applicant by providing information on
the services and/or support provided to the candidate. An authorized representative must complete the recommendation
agreement form and return it to the candidate for submission as part of the scholarship application. (See page 5)
NOTICE OF NONDISCRIMINATION
The GFWC Success for Survivors Scholarship does not discriminate in its selection policy, programs, or activities on the basis of
race, gender, color, creed, disability, national/ethnic origin, age, religion, sexual orientation, or disabled veteran/Vietnam era
veteran status.
APPLICATION AND DEADLINES
To be considered for the scholarship, applicants must submit a completed application and all requested materials
collectively, including:
Completed GFWC Success for Survivors Scholarship application form
Agency/counselor/social worker recommendation
One to Two letters of reference
Completed applications and requested materials must be emailed or postmarked to GFWC by 11:59 p.m. EST
on February 5, 2021.
All applications and materials should be emailed or sent by postal mail to:
Success for Survivors Scholarship
1734 N Street NW
Washington, DC 20036-2990
or
Programs@GFWC.org (Include “Scholarship” in the subject line.)
All information contained in this application will be considered condential. Any materials submitted, other than those
requested by GFWC, will not be considered. Incomplete applications will not be considered.
IMPORTANT DATES
Contact GFWC at Programs@GFWC.org or 202-347-3168 with any questions.
October 1, 2020
GFWC Success for Survivors Scholarship application process opens
February 5, 2021
GFWC Success for Survivors Scholarship application deadline
May 2021—June 2021
Recipients notied
July 2021
Monetary awards sent to recipients upon receipt of enrollment verication
2021 GFWC Success for
Survivors Scholarship
2021 GFWC Success for Survivors Scholarship Application 3
APPLICANT INFORMATION  ALL FIELDS REQUIRED
Name
Date of Birth
Last 4 Digits of Social Security #
Mailing Address
City State Zip Code
Primary Phone Secondary Phone Email
Referral Source (indicate how you learned of this scholarship)
Student Identication Number:
Are you a citizen or permanent legal resident of the United States? Yes No
MY EDUCATION HISTORY
Name of School City, State
Dates of Attendance
Start End
Major
Subject/Course
and
Degree Earned
Date of
Graduation
High School or GED
College
College or University address (Financial Aid/Accounts Payable Oce)
MY EDUC
ATION GOAL
Degree
Degree sought:
Are you currently enrolled in an eligible program? (see p. 1)
Yes No
Estimated graduation date:
List classes you are intending to take in the upcoming term:
Course No. Course Name
No. of
Credits
Start Date End Date
2021 GFWC Success for
Survivors Scholarship
2021 GFWC Success for Survivors Scholarship Application 4
Each answer should not exceed 500 words. Use additional pages if necessary.
Explain your educational goals and how this scholarship will help you achieve them.
List and explain your career goals.
Describe a challenge you have faced and the steps you took to overcome that challenge.
QUESTIONNAIRE
2021 GFWC Success for Survivors Scholarship Application 5
AGENCY/COUNSELOR/SOCIAL WORKER RECOMMENDATION  ALL FIELDS REQUIRED
T
o the Applicant:
To qualify for scholarship consideration you must identify an intimate partner violence service provider you have worked
with who is willing to attest to the services and support you have received as a survivor of intimate partner abuse. Please
complete this page and deliver it to your provider, along with the questionnaire. Both pages must be submitted to GFWC
along with all requested materials.
The purpose of this condential agreement is to assist GFWC in assessing your scholarship application. Any information shared
will be treated with discretion and respect.
I hereby give permission to any duly-authorized representative of my intimate partner violence service provider to supply
information requested by GFWC pertaining to myself. I release my provider and GFWC of any and all liability for sharing such
information. This release shall be in effect until I state, in writing, that it is no longer valid.
_____________________________________________________ _________________________
Signature of Candidate Date
Candidate Name
Provider Name (agency and/or company)
Contact Person
Provider Mailing Address
City State Zip
Email Phone
Website (if applicable)
2021 GFWC Success for
Survivors Scholarship
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signature
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2021 GFWC Success for Survivors Scholarship Application 6
Complete this questionnaire and return it to your applicant, along with the “Authorization for Release of Information” form
signed by you and the applicant. Incomplete applications will not be considered.
How long have you worked with the applicant?
What is your experience with the applicant?
What is your understanding of the applicant’s education goals?
Please describe why you believe the applicant is deserving of this scholarship award. Speak to your knowledge of the applicant’s
motivation, capability, and commitment to his/her career goals.
_____________________________________________________________________ __________________
Signature Date
AGENCY/COUNSELOR/SOCIAL WORKER RECOMMENDATION
Name
Title
Employer
click to sign
signature
click to edit
2021 GFWC Success for Survivors Scholarship Application 7
REFERENCES
Return this form to GFWC as part of your application. Letter(s) of recommendation must be included with your application.
Only one of these may be from a personal friend or family member. Your provider representative may be a reference. Others
you may consider asking for a letter of recommendation include an employer, teacher, and/or community leader.
Candidate’s Name
Reference #1
Name Relationship to Applicant
A
ddress
City State Zip
Phone Email
Reference #2
Name Relationship to Applicant
A
ddress
City State Zip
Phone Email
2021 GFWC Success for
Survivors Scholarship
2021 GFWC Success for Survivors Scholarship Application 8
?
SUBMIT YOUR APPLICATION
Include in your application:
GFWC Success for Survivors Scholarship application form
Agency/counselor/social worker recommendation
One or Two Letters of Recommendation
Send all materials by email or postal mail by 11:59 p.m. EST, on February 5, 2021, to:
GFWC Success for Survivors Scholarship
1734 N Street NW
Washington, DC 20036-2990
or
Programs@GFWC.org (Include “Scholarship” in the subject line.)
QUESTIONS?
Contact GFWC at 202-347-3168 or Programs@GFWC.org.
2021 GFWC Success for
Survivors Scholarship
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Completed 3 April 2021

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