Scholarship Application

Step 1 of 5 - Applicant’s Information

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Are you re-applying to the Ausome Scholarship Program?(Required)

Yes

Are you a resident of Florida? (If you answer no, you are not eligible for this scholarship and your application will not be considered.)(Required)

Yes

Is the applicant currently enrolled in the school in which the scholarship funds will be applied towards? (If you answer no, you are not eligible for this scholarship and your application will not be considered.)(Required)

Yes

Please enter the name of the school(Required)

Current grade or Academic Level(Required)

Applicant’s Full Name(Required)

Applicant’s Birthdate(Required)

MM slash DD slash YYYY

Applicant’s Address(Required)

State Issued ID(Required)

Drop files here or

Max. file size: 48 MB, Max. files: 1.

Please provide a copy of a state-issued ID as proof of the information above.

Autism spectrum disorder diagnosis(Required)

Drop files here or

Max. file size: 48 MB, Max. files: 1.

Please provide valid documentation of the applicant’s autism spectrum disorder diagnosis, failure to do so will disqualify the applicant

List up to 5 preferred activities: (such as sports, music, art, hobbies)(Required)

Applicant’s Gender(Required)

male

female

prefer not to designate

share more about gender identity

Applicant's Pronouns(Required)

he/him

she/her

they/them

add another pronoun

Please explain about your gender(Required)

Please list your pronouns(Required)

Parent(s)/Guardian(s) MUST complete a Parent/Guardian Form as part of the Ausome Scholarship Application.

If the parent(s)/guardian(s) live in the same household, please complete one Parent/Guardian Form together.
If there is one parent/guardian only, the parent/guardian will complete one Parent/Guardian Form. That parent/guardian should also submit a Non-Custodial Parent Waiver.
If your parents/guardians live in two separate households, they will each complete a separate Parent/Guardian Form.

Please select the option that describes your parent/legal guardian situation:(Required)

Parents/guardians are married to each other, or parent/guardian is widowed.

Parents/guardians are divorced, separated, or have never been married to each other.

Custodial parent/guardian live with applicant, but my second parent is incarcerated, or the whereabouts of my second parent are unknown.

Both parents/guardians are deceased or their whereabouts are unknown, or applicant is a legally emancipated minor or ward of the state without parents or guardians.

Caregiver(s)' Information

Primary Caregiver’s Full Name(Required)

Relationship to Applicant(Required)

Civil Status(Required)

Married

Single

Divorced

Widowed

Separated

Address(Required)

Preferred Language(Required)

Email(Required)

Phone Number (primary)(Required)

What is the best time and method to reach you?(Required)

phone call morning

phone call afternoon

text anytime

email anytime

Current employment situation(Required)

Employed

Unemployed

IRS Tax Transcript or Non-Filing Letter(Required)

Please provide a valid IRS tax transcript from the most recent year. If you are unemployed and haven’t filed taxes in the last 3 years, please submit a Non-Filing Letter from the IRS. (Link to retrieve both: https://www.irs.gov/individuals/get-transcript )

Drop files here or

Max. file size: 256 MB, Max. files: 1.

Completed Level of Education(Required)

High School Diploma

Bachelor’s Degree

Master’s Degree

PhD

None of the Above

Which best describes your relationship to the applicant’s other biological or adoptive parent?(Required)

Divorced or Separated

Married

Never Married

Remarried (after being divorced or widowed from the other biological/adoptive parent)

Unmarried but both parents living together

Widowed

My/our child has been homeschooled.(Required)

Yes

My/our child has received/ receives support for social, emotional, or behavioral difficulties (e.g., counseling, medication, school-based support).(Required)

Yes

My/our child has been dismissed, suspended (in or out of school), placed on probation, or received other disciplinary action from school.(Required)

Yes

My/our child has withdrawn from school voluntarily for an extended period of time.(Required)

Yes

Please describe how you are involved in supporting your child's education.(Required)

Please provide any additional information about your child or family situation you were not able to tell us about in the answers above.

Parent Financial Information

The applicant's biological or adoptive custodial parent(s)/guardian(s) (with whom the applicant resides full time or a greater portion of the time), should provide tax information.

If the custodial parents/guardians are married to one another, the financial information provided should be the combined amount for the custodial parents/guardians.
If the custodial parent/guardian has remarried, the stepparent's financial information should be included; please note that in this section, all uses of "you/your" or "parent(s)/guardian(s)" also includes the stepparent.
If there is a noncustodial parent/guardian, he/she will complete their own form - you do not need to include their information here. The applicant should provide the noncustodial parent's/guardian's email address as a part of the Parent Information Request section on the student application.

PLEASE NOTE FINANCIAL ELIGIBILITY: To be eligible for the Ausome Scholarship Program, the applicant must demonstrate unmet financial need. We will consider applicants within the poverty guidelines stated by the Federal Register. (https://www.federalregister.gov/documents/2022/01/21/2022-01166/annual-update-of-the-hhs-poverty-guidelines)

Were you required to file a Federal Tax Return in 2022?(Required)

Yes

Please enter your 2022 Combined Household Income (AGI)(Required)

Please provide an explanation of any special financial circumstances relevant to your income information here (e.g., business losses, extraordinary family medical expenses, expenses for disabled children)

Non-Custodial Parent Waiver

Non-Custodial Parent Full Name(Required)

Can we contact the non-custodial parent via email?(Required)

Yes

Please provide Parent/Guardian Email(Required)

Can we contact the non-custodial parent via Phone Number?(Required)

Yes

Please provide Parent/Guardian Phone Number(Required)

Is there a safety concern regarding contacting the non-custodial parent?(Required)

Yes

Does your child receive any financial support from the non-custodial parent, including child support payments?(Required)

Yes

Please explain any additional circumstances regarding your or your student's relationship with the non-custodial parent, particularly any that relate to the above questions.

Are there any additional reasons that would prevent the non-custodial parent from completing the non-custodial parent form?

Consent(Required)

I certify, to the best of my knowledge, that the information on this waiver is complete and accurate. Falsification of any information will cause my child’s disqualification from the Ausome Scholarship Program.

I Affirm(Required)

Parent/Guardian of Applicant to Ausome Scholarship Program Policies of Application.

Consent(Required)

I understand that because my child is under age 18, as parent or guardian, I must also agree to these Terms and Conditions in order for my child’s application to be complete and eligible for review.

I Affirm(Required)

Consent(Required)

I certify, to the best of my knowledge, that the information on this application is complete and accurate. Falsification of any information will cause my child’s disqualification from the Ausome Scholarship Program application process and the Ausome Scholarship Program. 

I Affirm(Required)

Consent(Required)

I understand it is my responsibility to make sure that all application forms, are submitted by the required deadlines. If any form is not complete, the application may be disqualified from the selection process and my child may not be considered for the Ausome Scholarship Program. 

I Affirm(Required)

Consent(Required)

I understand that the information and documentation submitted for this application and other information the Ausome Foundation obtains (including but not limited to family financial, medical reports, and other confidential information), will only be used for the Ausome Scholarship Program application process and will be managed as described in the Ausome Foundation Scholarship Program Privacy Policy, which is available here (attach PDF policies).

I Affirm(Required)

Consent(Required)

I understand and agree that my child and I will not be permitted to see the Documentation and School Forms submitted about my child, and I give the school staff to disclose all information requested by the Ausome Foundation. I understand that if I do not provide these consents, my child’s application will not be eligible for review.

I Affirm(Required)

Consent(Required)

I understand that this application, upon receipt, becomes the property of the Ausome Foundation Corp.

I Affirm(Required)

Consent(Required)

I hereby and in accordance with Federal Copyright Law, I authorize Ausome Foundation Corp., whom we will call “The Organization”, to use photographs or video recordings that include my image and that of my minor child (at ) and / or attorney-in-fact, in campaigns, promotional and other support material that are considered pertinent for the dissemination and promotion of "The Organization" and that are distributed in the country or abroad by any means, whether printed, electronic or through another type.
Likewise, based on the articles of the Federal Copyright Law, it is my wish to express that this authorization is voluntary and totally free, therefore, "The Organization" is free to use, reproduce, transmit, retransmit, show publicly, create other derivative works of my image in the promotional campaigns carried out by any means, as well as the fixation of the aforementioned image in projections, videos, graphics, texts, slides and all the supplementary material of the promotions and campaigns, establishing that it will be used solely and exclusively for the purposes indicated.
In that sense, I authorize the use of my name and any comment that I may have made while the video was being recorded and that such comment be edited for the stated purposes.
I declare that I waive all right to inspect or approve the video or photography sequences.
I authorize that my image and that of my minor child and / or attorney-in-fact be used for as long as "The Organization" deems appropriate; however, said authorization may be revoked by writing addressed to the administrative area of "The Organization".
I declare that I am of legal age and that, if not, one of my parents or legal guardians has signed the Consent / Legal Release form that is included at the end of this document.

I Affirm(Required)

Signature(Required)

Please indicate how you first learned about the Ausome Scholarship Program.(Required)

School

Personal Reference

Social Media

Ausome Foundation thanks you for your cooperation. For further information about Ausome Foundation visit www.ausomefoundation.org. By clicking the Submit button, I certify that the information reported is true and accurate to the best of my knowledge.

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