Grant Application | Autry Foundation

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Grant Application.
Please fill out this form, and we'll get back to you as soon as possible.

First Name

Last Name

Email

Address

Phone

Do You Live in the Auty District? Grants are for In District Students Only.

Yes

No

Are you claimed as a dependent on anyone’s tax return?

Yes

No

If Yes, Whose?

Date of Birth

Marital Status

Married

Single

Separated

Divorced

If Married, Spouse's Name:

If Married, Spouse's Employer:

Current Employer:

Are you currently in default on a federal student loan?

Yes

No

Have you previously received Autry Educational Foundation Assistance?

Yes

No

If Yes, When and for What Amount?

If Yes, For Which Autry Tech Class?

Have you been convicted of, pled guilty or not contest to, or received a deferred sentence for a misdemeanor or a felony offense.

Yes

No

If yes, what was the offense?

Education Received

HS Diploma

GED/HiSET

Other

If Other, Be Specific:

Which Autry Class Will Funding Assist and Anticipated Start Date:

Current Monthly Income Amount of Applicant:

MONTHLY INCOME:

Monthly Income: Spouse

Monthly Income: Parent

Monthly Income: Other Individual (if living in the same household)

Monthly Income: Child Support or Alimony

Total Monthly Income:

Are you currently, or will you be receiving assistance from any of the following in the next 12 months?

Autry Educational Foundation

BIA

Dept. of Rehabilitative Services

Disability

OTAG

Scholarships

TANF

WIOA

Vance/City of Enid Vocational Scholarship Program

Low Income Housing

Pell

Social Security

Unemployment

Workers' Compensation

Military housing, food, living allowances

Other

If Other, Be Specific:

Total Assistance Income:

MONTHLY EXPENSES:

Housing

Auto Payment

Auto - Gas

Auto - Insurance

Utilities

Child Support (Paid)

Loan Payment

Food

Phone

Other Obligations

Total Monthly Expenses:

Applicant is usually expected to pay a portion of costs. Foundation assistance is not intended to fully fund a student’s education. Please explain to the committee why you need assistance.

Tuition Cost

Books & Supplies Cost:

Amount Requested

State why you have applied for these funds and for what the funds will pay. Please provide complete details.

What do you plan to accomplish once you have completed this training? What wage do you expect to earn?

I certify that all of the information on this form is true and correct to the best of my knowledge. If asked, I agree to provide proof of the information that I have given on this form. I am in good standing with Autry Technology Center

USE MOUSE OR MOUSE PAD TO SIGN BELOW:

Your Signature (Or Parent/Guardian If Under 18)

Autry Educational Foundation

1201 W. Willow

Enid, OK 73703

E-mail: foundation@autrytech.edu

Phone: (580) 242- 2750

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Grant Application. Please fill out this form, and we'll get back to you as soon as possible.

Grant Application.
Please fill out this form, and we'll get back to you as soon as possible.