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ApplicationInstructions PDF

This document is an application signature page for application #383665. It requires the applicant to initial and sign in several places to certify the accuracy of the application and household income reporting. It also requires the applicant to certify that no parent or guardian associated with the application is an owner or operator of an eligible private school. The document provides instructions on submitting required supporting documents with the application.

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Elizabeth Gray
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239 views8 pages

ApplicationInstructions PDF

This document is an application signature page for application #383665. It requires the applicant to initial and sign in several places to certify the accuracy of the application and household income reporting. It also requires the applicant to certify that no parent or guardian associated with the application is an owner or operator of an eligible private school. The document provides instructions on submitting required supporting documents with the application.

Uploaded by

Elizabeth Gray
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Application Signature Page for Application # 383665

Please note: While you signed an electronic version of this form, the hard copy is
required. Please initial and sign where indicated and return with any other documents
that were requested.
INITIAL HERE -> _____ I certify that all the information provided in this
application and all supporting documentation is true,
correct and complete and that ALL household income
has been reported. I understand that intentional
misrepresentation could result in the scholarship being
denied or revoked and in criminal prosecution.
Per Florida Statute SB2126; Owner or operator includes:
An owner, operator, superintendent, or principal of an
eligible private school or a person with equivalent
decision making authority over an eligible private school.
An eligible nonprofit scholarship-funding organization:
May not provide scholarships to a child of an owner
or operator.
INITIAL HERE -> _____ I certify that no parent/guardian of a child on this
application is an owner, operator, principal, or person
with equivalent decision-making authority of an eligible
private school.
INITIAL HERE -> _____ I agree to follow the rules and responsibilities for
parents as they apply to the program as set forth in the
Parent Handbook.
SIGN HERE ->________________________________________________________
Arisleidy Pena

DATE

SIGN HERE ->________________________________________________________

SigPage_2015

Household Member
Arisleidy Pena

Required Documents

If weekly: Provide a copy of your most recent four (4) in a


row pay check stubs / LES showing your GROSS wages
If every-other week: Provide a copy of your most recent
two (2) in a row pay check stubs / LES showing your
GROSS wages
If two times a month: Provide a copy of your most recent
two (2) in a row pay check stubs / LES showing your
GROSS wages
If once a month: Provide a copy of your most recent pay
check stub / LES showing your GROSS wages
If once a year: Provide a copy of your previous years
W-2 or 1099
If other: Provide an official letter from your employer
stating the frequency of your wages and the total current
gross monthly amount you receive

Provide your application payment. You can pay this fee


online using a credit/debit card.

Provide your initials on the signature page where indicated


by the arrows. Your initials are the first and last letters of
your name. For example: John Smith would be J.S.

Provide the signature page, signed by you, that will print


when you finish your application.

Provide a copy of a current U.S. federal or state issued ID


with a signature. Examples of an ID include: United States
Passport, U.S. Military ID, Drivers license, and state
identification card.

Please have someone who does NOT live in your house


complete and sign the Step Up For Students form #1050HC. This form will print when you complete your
application. In addition, provide a copy of ONE
document from the list below. The document must
include your name and address:
Current months statement from SSI OR,
Current months statement from VA OR,
Current months SNAP statement OR,
Current months statement from TANF OR,
Current S8/HUD lease OR,
Current Mortgage, monthly mortgage statement,
residential lease agreement OR,
Deed OR,
Current Paystubs with address listed OR,
Current Medical or health care benefits or enrollment
statement with address listed OR,
Current homeowners or renters insurance policy or bill
OR,
Current automobile insurance policy or bill OR,
Utility bill (water and/or electric) not more than two
months old

Provide a copy of ONE document from the list below.


The document must include the name and address of this
child / student:
Current months statement from SNAP OR,
Current months statement from TANF OR,
Current Medical or health care benefit or enrollment
statement OR,
Florida Kidcare or Medicare Statement OR,
Public school transcripts OR,
Official court custody documents showing the custodial
parents name

Provide a copy of ONE document from the list below.


The document must include the name and address of this
child / student:
Current months statement from SNAP OR,
Current months statement from TANF OR,
Current Medical or health care benefit or enrollment
statement OR,
Florida Kidcare or Medicare Statement OR,
Public school transcripts OR,
Official court custody documents showing the custodial
parents name

Benjamin Cruz

Dariel Pena

#1050-HC
Verification of Household Composition
Step Up For Students
Application # 383665

PLEASE ASK A FRIEND, NEIGHBOR, PASTOR, ETC. TO COMPLETE THIS


FORM. THIS PERSON MUST NOT BE RELATED TO YOU AND CANNOT LIVE
WITH YOU.
Arisleidy Pena
619 Whispering Cypress Ln
Orlando Florida, 32824
Do the people listed below live at this address? YES? / NO *
*If they do not live at the address listed above, provide the address of the home
where they live:
Street Address:_________________________________________________
List ALL adults and children who live at the address listed above.

Please indicate their ages and relationship to Arisleidy Pena


Household Members Name

Relationship to

Age

Arisleidy Pena
1 ______________________________________ ___________________________ _____________
2 ______________________________________ ___________________________ _____________
3 ______________________________________ ___________________________ _____________
4 ______________________________________ ___________________________ _____________
5 ______________________________________ ___________________________ _____________
6 ______________________________________ ___________________________ _____________
7 ______________________________________ ___________________________ _____________
8 ______________________________________ ___________________________ _____________
9 ______________________________________ ___________________________ _____________
10______________________________________ ___________________________ _____________

Under penalties of perjury, I certify that the information presented is true and accurate to
the best of my knowledge and belief. The undersigned further understands that providing
false representations herein constitutes an act of fraud. False, misleading or incomplete
information may result in the denial of the scholarship application or revocation of a
scholarship award.
_________________________________________________________________________________________________
Name of Person Completing Form (please print clearly)
Phone #
Date
_________________________________________________________________________________________________

Street Address of Person Completing Form

City

State

Zip

_________________________________________________________________________________________________
Signature of Person Completing Form
Relationship of Person Completing Form to Arisleidy Pena
SUFS1050HHCeng.2015

INSTRUCTIONS FOR SENDING YOUR DOCUMENTS TO STEP UP FOR


STUDENTS
1. The following documents must be sent in as part of your application:

The signed and initialed Application Signature Page

All requested supporting documentation

2.

Including any required Step Up For Students Statement that must be


signed

Please do the following:

Write your Application ID number on the upper, right hand corner of each
document (if it is not printed)

3.

Your Application ID number is: 383665

Put the documents in the following order

Application Signature Page

Student Report Card/s (if applicable)

Food Stamp Documents (if applicable)

Income documents (pay stubs, unemployment documents, etc.)

Child Support Documents

Court Documents

Tax Return (if applicable)

Step Up For Student Statements

Any other documents

Application Submission Options:

FAX

If you fax your documents, you must use the Step Up For Students

Fax Cover Sheet. The cover sheet includes your Application ID


Number, your name, and the fax number to use for submitting your
documents.

UPLOAD

4.

You can also upload the documents directly to your application. To do


this, please log in to your online Step Up account, click on where it
says "Print and send documents" and follow the instructions on this
page.

Checking your application status:

You can check your application status online at www.stepupforstudents.org

On the home page, click on Logins

Under Parent Login choose the first option which says:


To continue an application you have started, or to check the status of
your application, please click here.

FAX COVER SHEET


TO: Document Processing Center
FAX NUMBER: 904-592-6548
APPLICATION ID NUMBER: 383665
FROM: Arisleidy Pena
LAST FOUR NUMBERS OF PRIMARY PARENTS SOCIAL SECURITY
NUMBER:
NUMBER OF PAGES IN THIS FAX, INCLUDING THIS COVER PAGE:
_____________________

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