Fillable 9129CityOfCheyenne FORM City of Cheyenne Housing & Community Development Scholarship Application

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9129CityOfCheyenne FORM City of Cheyenne Housing & Community Development Scholarship Application

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City of Cheyenne
Housing & Community
Development
SCHOLARSHIP APPLICATION
Eligibility Requirements:
1. Resident living within the city limits of the City of Cheyenne.
2. Qualify as a low or moderate income person or household.
Section 8 income levels are attached.
3. 2.5 GPA or higher.
4. Priority will be given to students who are head of households,
non‑traditional students, students who need vocational rehabilitation
or are GED graduates.
5. Applicants need to attend LCCC campus in Cheyenne.
Required Materials:
1. Copy of Parent(s) and/or Student’s last year’s income tax return with
W‑2’s attached (signed).
2. Most recent employment checks stub within last 3 months and proof of
any other income (SSI, AFDC, Retirement, etc.). Please blackout social
security number before submitting.
3. Copy of Photo Identification (driver’s license, passport, etc.).
4. Proof of Residency (rent receipt, utility bill, letter from your employer or
official government document).
5. Copy of high school transcript OR transcript from last college attended
OR proof of GED.
6. One page essay on the importance of higher education to you.
All required materials must accompany application. Please fill out all lines, put
“N/A” if not applicable. Incomplete applications will not be processed.
Deadline: Return completed application to the following address by: July 1
City of Cheyenne
Housing & Community Development Office
2101 O’Neil Avenue
Cheyenne, WY 82001
Produced by LCCC Public Relations PRS 9129 11/16
PERSONAL INFORMATION
Name
Current Street Address
PLUS
Post Ofce Box
City, State, ZIP
Phone Number
Email Address
TOTAL HOUSEHOLD INCOME
Student $ Other $
Other $ Other $
Other $ Other $
Do you expect your Total Annual Income to increase within the next 6 months?
Yes
No
If “yes” please explain:
HOUSEHOLD SIZE
Family Size:
1 person
2 persons
3 persons
4 persons
5 persons
5+ persons
FINANCIAL ASSISTANCE
Please list ALL nancial assistance received and amount:
AMOUNT
(grants, loans, gifts, scholarships, etc.)
$
$
$
$
$
Expected shortage of funds to continue education
$
Laramie County Community College Student
Full-time
Part-time
Indicate courses to be taken next semester
Anticipated degree Year of completion
_________________________________________________________________
Signature Date
THIS FUNDING WILL BE SENT TO LCCC
TO BE USED TOWARDS THE COST OF ATTENDANCE.
Essay on the importance of higher education to you.
SCHOLARSHIP APPLICATION
CHECKLIST
ement, etc.).
Please blackout social security numbers before submitting.
Copy of Parent(s) and/or Student’s last year’s income tax return with
W
‑2’s attached (signed). Most recent employment check stubs within last
3 months and proof of any other income (SSI, AFDC, Retir
Copy of Photo Identification (driver’s license, passport, etc.).
Proof of Residency (rent receipt, utility bill, letter from your employer or
official government document).
Copy of high school transcript OR transcript from last college attended
OR pr
oof of GED .
One page essay on the importance of higher education.
ALL REQUIRED MATERIALS MUST ACCOMPANY APPLICATION.
INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED.
CITY OF CHEYENNE
HOUSING & COMMUNITY DEVELOPMENT OFFICE
FEDERAL CIVIL RIGHTS LAW
NOTE: COMPLETION OF THIS FORM IS OPTIONAL
This information is requested solely for the purpose of determining compliance
with Federal Civil Rights Law and your response will not
affect consideration of your application.
Race / Ethnicity of Applicant
Hispanic or Latino
Not Hispanic or Latino
White
American Indian
African American
Asian
Alaskan Native
Native Hawaiian
Pacific Islander
Multi‑race
HOUSING & URBAN DEVELOPMENT (HUD)
SECTION 8 INCOME LEVELS (DATED 3-30-16)
FOR CHEYENNE, WYOMING
Family Size Very Very Low Very Low Income Moderate Income
(30% of Median) (50% of Median) (80% of Median)
1 Person $15,900.00 $26,500.00 $42,350.00
2 Persons $18,200.00 $30,250.00 $48,400.00
3 Persons $20,450.00 $34,050.00 $54,450.00
4 Persons $24,300.00 $37,800.00 $60,450.00
5 Persons $28,440.00 $40,850.00 $65,300.00
6 Persons $32,580.00 $43,850.00 $70,150.00
7 Persons $36,730.00 $46,900.00 $75,000.00
8 Persons $40,890.00 $49,900.00 $79,800.00
Submission Instructions
Submit application before July 1.
and mail to: City of Cheyenne
Housing & Community Development Oce
2101 O’Neil Avenue
Cheyenne, WY 82001
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9129CityOfCheyenne FORM City of Cheyenne Housing & Community Development Scholarship Application

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Completed 15 February 2020

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