Application for Disbursement of Maoteen Scholarship Funds

Application for Disbursement of MAOTeen Scholarship Funds

Completion ofthisform and theattachmentofthenecessary documentationarerequired for the paymentofallscholarships.No exceptionswillbemadewithouttheconsentoftheMAOTeenScholarshipCommittee. Noformswillbeacceptedviaemailorfaxwithouttheconsentofthescholarshipchairman.Pleaseallow30daysfromthereceiptofallrequireddocumentationforpaymentstobeprocessedandpaid.

DATEOF APPLICATION_DATEOFHSGRADUATION_

CONTESTANTNAME

NAMEOFSTATETITLEANDYEAR

ADDRESSCITYST_ZIP

PHONESEMAIL(HOME) (CELL) (EMAILADDRESS)

PARENTS’NAMES_

PARENTS’ADDRESS_

PHONESEMAIL_(HOME) (CELL) (EMAILADDRESS)

NAMEANDEMAILADDRESSOFYOURSTATETEENEXECUTIVEDIRECTOR:

(LISTALLLOCALANDSTATESCHOLARSHIPSYOUHAVEWONDURINGTHISPAGEANTSEASON.THESEMUSTBEPAIDINFULLBEFOREYOUCANAPPLYFORYOURNATIONALSCHOLARSHIP.)

COLLEGE/UNIVERSITY INFORMATION

NAMEOFCOLLEGEORUNIVERSITY_

WEBSITEADDRESSOFSCHOOL

ADDRESS

(WHERETHESCHOLARSHIPCHECKISTOBESENT)

NAMEOFCONTACTPERSON_

PHONEEMAILOFCONTACTPERSON

(OFFICE)(EMAILADDRESS)

STUDENTIDNUMBER

LISTALLFINANCIALAID(LOANS;GRANTS;SCHOLARSHIPS,ETC.)

TheFollowingInformationIsRequiredAndMustBeAttachedToThisDocument:

□Letterfromcontestantrequestingpaymentofscholarshiptoheruniversity/college.

□Letterfromstatepageantexecutivedirectorverifyingthatallstateandlocalscholarshipmonieshavebeenexhausted,withoutforfeiture.

□Original,detailed,andcurrentcopyoftuitionbill,showingabalancedue.(“Zerobalance”tuitionstatementsarenotaccepted.)Billmustshowall

otherscholarshipassistance.Billmustalsobeproducedafterthe“add/drop”dateforeachsemester.(Refertocontract,AttachmentBforfurtherexplanationofrules.)

□(Ifapplicable)bookreimbursementforcurrentsemesteronly–attachoriginalreceipts.(Refertocontract,AttachmentBforfurtherexplanationofrules.)

□(Ifapplicable)copyof“oncampus”housingbill.(Refertocontract,AttachmentBforfurtherexplanationoftherules.)

ïAlltuitionstatementsmustbeforthecurrentsemester. Wedonotpaypastorfuturetuitioncharges. Ifyourtuitionstatementshowsa

zerobalanceforthecurrentsemester,MAOTeenwillnotpayyourscholarship.Theremustbea“balancedue”onyourtuitionstatement.

ïAllscholarshippaymentsarepayabledirectlytothecollege/university.

NATIONALSCHOLARSHIPUSAGEMUSTBEGINWITHINONEYEAROFHIGHSCHOOLGRADUATION.(SINCEHIGHSCHOOLGRADUATIONDATESVARYACROSSTHECOUNTRY,MAOTeenUSESTHEUNIVERSALDATEOFMAY31OFTHECONTESTANT’SGRADUATIONYEAR.)ALLSCHOLARSHIPMONIESWILLBEFORFIETEDIFNOTUSEDWITHINTHISTIMEFRAME.)

THEREARETWO(2)JUSTIFICATIONSFORTHEFORFEITUREOFSCHOLARSHIPS.

1.FailuretoadheretoallscholarshiprulesasspecifiedinintheMAOTeenNationalContract;AttachmentB,ScholarshipRulesAndRegulations.

2.ScholarshipsmaybeforfeitedifanymisrepresentationsaremadeastotheeligibilitytocompeteintheNationalFinals.

Scholarshipsareavailableforfour(4)yearsfromthedateofhighschoolgraduation.Restrictionsdoapply.(Seecontract,AttachmentB)

ïNationalfundswillbeforfeitedifcontestantforfeitsanymoneyfromthestateand/orlocallevel.

ïMealplansarepayableifthecontestantis:a.)Livingoncampus;b.)Boardiscovered;andc.)Sheisafulltimestudent-whichisaminimumof12semesterhours.

ITISIMPORTANTTHATYOUREVIEWATTACHMENTBOFTHENATIONALCONTRACTFORCOMPLETERULESANDREGULATIONSREGARDINGTHE PAYMENTOFSCHOLARSHIPFUNDS.THENATIONALCONTRACTHASBEENUPDATED TOBECOMPLIANTWITHCURRENTIRSRULESANDREGULATIONSREGARDINGTHEPAYMENTOFSCHOLARSHIPS.

IHAVEREADTHISDOCUMENTANDATTACHMENTBOFTHECONTRACT.IUNDERSTANDTHATIMUSTFOLLOW THESEINSTRUCTIONSANDTHERULESANDREGULATIONSFOUNDINTHENATIONALCONTRACTREGARDINGTHEDISBURSEMENTOFALLSCHOLARSHIPS.IALSOAGREETHATANYDISPUTETHATMAYARISECONCERNINGTHEPAYMENTOFSCHOLARSHIPSWILLBEREVIEWEDBYTHESCHOLARSHIPCOMMITTEEANDTHEIRDETERMINATIONSHALLBETHEFINALWORDOFTHEMAOTEENORGANIZATION.

SIGNATUREOF CONTESTANTSIGNATUREOFPARENTORGUARDIAN

DATEDATE

INSTRUCTIONS:

Makecopies,foryourfiles,ofallthedocumentsyouaresending.

SendalldocumentationviaRegisteredMail,FedEx,orsomeothertraceablemeans.

Sendthisformwithallrequiredoriginaldocumentationto:

MAOTeen SCHOLARSHIP COMMITTEE12718 DUPONT CIRCLE, SUITE A5BTAMPA, FL 33626

FERPAFORM

Updated1/2016

AUTHORIZATIONTORELEASEINFORMATION

StudentConsentforEducationRecordstobereleasedto

Parent(s),LegalGuardian(s),OtherTuitionProvider(s),orOtherIndicatedIndividual(s):

Student’s Name:

StudentID#:

PLEASEREAD:

InaccordancewiththeFamilyEducationalRightsandPrivacyActof 1974 (FERPA), the undersigned student herebypermits(NameofInstitution)_ anditsrepresentativestodisclosetheinformationspecifiedbelowtothefollowingindividual(s)oragency(ies):

Name:Amanda Tomasi,Business and Scholarship Manager,MissAmerica’sOutstandingTeen,Inc. Name: ______Name: Name:______Thisconsentshallbevalidthroughoutthestudent’senrollmentat(NameofInstitution) and thereafter but may be modified or rescinded in writing by the student. The parent(s), legal guardian(s), tuitionprovider(s),orotherindicatedindividual(s)agreethattheyshallnotdisclosethespecifiedinformationtothirdpartieswithoutthestudent’sauthorization.

INFORMATIONTOBERELEASED:

The following information from my records at (Name Of Institution)may bereleasedtotheabovespecifiedperson(s):

Grades and academic standingAcademicInformation_X Disciplinerecords

Tuitionandfeestatus_XOther,pleaseSPECIFY: NumberofsemesterhoursAllrecordsorinformation

IhavereadandunderstandthecontentsofthisconsentformpertainingtotheFamilyEducationalRightsandPrivacyActof1974.Student’s Signature: Date:______

MAOTscholarshipapplication1.16MissAmerica’sOutstandingTeen,Inc.isa501(c)(3)tax-exemptorganization.

MAOTeenNATIONAL CONTRACT •ATTACHMENTB • SCHOLARSHIP RULESAND REGULATIONS

1.SCHOLARSHIP USAGE:

a.Scholarshipsmaybeexpendedforcurrentcollege/universitytuition,on-campusroomandboard,andcoursebookspurchasedintheschoolbookstore,only.

b.Parkingfines,buspasses,IDcards,libraryfines,healthinsuranceorothernon-tuitionrelateditemssuchascoursefeesareNOTcovered.

c.Mealplansarecoveredifthestudentis(a)livingoncampus,(b)boardiscovered,and(c)sheisenrolledasafulltimestudent(aminimumof12semesterhours).

d.Other“posthighschool”tuitionmaybeconsidereduponwrittenrequestfromthestudent.(ie:technicalschools,performingartsschools).TheserequestsarepaiduponthefullexaminationandvoteoftheMAOTeenScholarshipCommittee.

2.REQUESTING USAGE:

a.The“ApplicationforDisbursementofMAOTeenScholarshipFunds”(knownasthe“Application”)mustbefullycompletedandallrequireddocumentationmustbeattached.Additionalcopiescanbedownloadedat

b.Unlesspriorpermissionisgranted,alloriginaldocumentationmustbemailed(notfaxedore-mailed)totheaddresslistedonthe“Application”.

c.RequestsforscholarshipsareprocesseduponreceiptifALLrequireddocumentationasdescribedinthe“Application”.

d.Scholarshipscannotbepaidtoatuitionstatementthatshowsa“zero”balanceforthecurrentsemester.

e.Tuitionstatementsmustbeforthecurrentsemesterandshowanitemizedlistofallfees,charges,andcredits,includingotherscholarshipsthathavebeenawarded.

f.Ourscholarshipspay“thegap”.“TheGap”isdefinedasthatportionofthestudent’scurrentsemestertuition,on-campusroom/board,and/orbookspurchasedintheschoolbookstorethatarenotcoveredbyotherfinancialassistance.(Example:Financialaid;loans;otherscholarships,etc.)

g.TuitionstatementsmustbeproducedAFTERthe“add-drop”dateforthecurrentsemester.

h.Tuitionstatementsmustshowthenumberofsemesterhoursforthecurrentsemester.(Ifyourstatementdoesnotshowthisinformation,acopyofthestudent’sclassschedulewillsuffice.)

3.ADDITIONALSCHOLARSHIPPAYMENTGUIDELINES:

a.ON-CAMPUSroomandboardispayableforfulltimestudents,only.Thisdoesnotincludekeyfeesordeposits.Utilities(electric,gas,cable,landlinephone,etc.)arenotcoveredunlesstheyareincludedintherentalfee.

b.AllscholarshippaymentsmustbeforCURRENTexpensesonly.(Currentexpensesaredefinedasthosefallingwithinthecurrentsemester.)

c.Contestantmustmaintainatleast12credithourspersemesterasafulltimestudent.

d.Parttimestudentsmustmaintain9credithourspersemester.

e.Graduatestudentsmustmaintain9credithourspersemester.

f.Pleasecontactyourpersonaltaxconsultantforanyquestionsregardingyourpossibletaxliabilityinregardtoscholarships.MAOTeenisnotresponsibleforthedisseminationofIRSrulesandregulations.

4.USAGEANDFORFEITURE:

a.Contestantsreceivingscholarshipsatthenationallevelmustusethescholarshipswonatthestateandlocallevelpriortoapplyingforthefundsheldintrustatthenationallevel.

b.Verificationmustbesubmitted,inwriting,fromtheStateExecutiveDirector,thatallstateandlocalmoneyhasbeenexhausted,withoutforfeiture.

c.NationalScholarshipusagemustbeginwithinONEyearofhighschoolgraduation.(Sincehighschoolgraduationdatesvaryacrossthecountry,MAOTeenusestheuniversaldateofMay31ofthecontestant’sgraduationyear.)ALLSCHOLARSHIPMONIESWILLBEFORFIETEDIFNOTUSEDWITHINTHISTIMEFRAME.)

d.Ifthereareextenuatingcircumstancesthataredelayingtheusageofacontestant’sscholarshipmonies,shemaysubmitawrittenrequestforanextensionofoneyear.ThisrequestmustbereceivedPRIORtotheendoftheone-year(May31)periodfollowinggraduationinordertobeconsidered.Iftherequestisreceivedpasttheone-year(May31)deadline,itwillbedeniedandthemoneywillbeforfeited.

e.Iftheextensionprocesshasbegun,MAOTeenwillacceptrequestsforscholarshipextensionsforatotaloffour(4)yearsfollowingtheoriginalgraduationdate.Attheendoffour(4)years,(usingtheMay31cutoffdate),allunusedscholarshipmonieswillbeforfeited.

f.Onceacontestantbeginsusageofherscholarshipfunds,ifthereoccursacontinuous,uninterruptedone(1)yearperiodinwhichthereisnoactivityinheraccount,thebalanceofthataccountwillbeforfeited.

g.ExtensionrequestswillNOTbeacceptedviae-mailorfax.AllextensionrequestsmustbesentviaRegisteredMail,FedEx,orsomeothertraceablemeans.Ifanextensionhasbeengranted,youwillreceivealetterfromtheMAOTeenScholarshipCommittee.Donotassumeyouhavereceivedanextensionuntilyoureceiveourwrittenapproval.

h.Itistheresponsibilityofthecontestanttomaintaincontactwiththenationalorganizationregardingallscholarshippayments.MAOTeenISNOTRESPONSIBLEFORMAINTAININGACALENDAROFGRADUATIONDATESFOROURPARTICIPANTS.

5.DISPUTES:

a.Alldisputesmustbesent,inwriting,totheScholarshipCommittee.

b.AlldisputeswillbefairlyexaminedbytheMAOTeenScholarshipCommittee.Everyeffortwillbemadetofairlyresolveanyissuethatmayariseregardingscholarshippayments.

c.ThedecisionoftheScholarshipCommitteeshallbefinalandbinding.

I,,havereadandunderstandtheMissAmerica’sOutstandingTeen,Inc.ScholarshipRulesandRegulations.

______

DateSignatureofContestant

______

DateSignatureofParentorGuardian

(COPYOFATTACHMENTB/MAOTeenNATIONALCONTRACT)

Revised1/16