First Name

Last Name

Date of Birth

Primary Phone

Primary Email

Street Address

City

State

Zip code

Are you currently working?

Yes

If you answered Yes, please put the name of your employer and the title of your position.

Total houshold income:

$0 - $40,000

$40,000 - $60,000

$60,000 - $80,000

$80,000 +

Students must submit the 2022/2023 FAFSA in order to receive the Need-Based Scholarship. Please note that Justice College is currently in the accreditation process and does not have a "school code" for FAFSA. In the mean time, please submit pay stubs to "admissions@justicecollege.org" with the students first and last name in the subject line.

In 500 words or less, please explain your need and why you are applying for this scholarship.

Applicant Signature (Click and drag to sign)

Signature Date