WIlhelmina Holder Student Assistance Fund - Application

Thank you for your interest in the Wilhelmina Holder Student Assistance Fund. Please complete this application fully and attach any proof of your current need. Applications are accepted on a rolling basis and awards will be distributed quarterly (January, May, August, November) or monthly for emergencies. *Emergency Applications will be reviewed every 2nd Friday of the month. If there is an urgent need, email wholderefund@gmail.com after submitting.

Background/Demographic Info.

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1. First & Last Name: (Required.)

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2. Phone Number: (Required.)

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3. Email Address: (Required.)

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4. Home Address: (Required.)

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5. Are you a resident of Essex County or Greater Newark area? (If not, please do not complete this application) (Required.)

Yes

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6. Date of Birth: (Required.)

Date / Time

Date

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7. Gender (select one): (Required.)

Male

Female

Non-binary

Prefer not to answer

Other (please specify)

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8. Race: (Required.)

Asian

Black, African American or African Origin

Hispanic, Latinx or Spanish Origin

Indigenous People or First Nation/Native American Indian/Alaska Native

Native Hawaiian or Other Pacific Islander (NHOPI)

White/Caucasian

Mixed-race/Multi-race

Other/Not listed here or prefer to self describe (please specify):

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9. Emergency Contact Name: (Required.)

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10. Emergency Contact Number: (Required.)

School/Program Information

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11. Required: Post-Secondary School/Program Name: (Required.)

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12. Type of School/Program you are enrolled in (select one): (Required.)

College/University – Associate

College/University – Bachelor

College/University – Graduate or Professional Degree

Certificate Program

Military

Other (Please list in your application)

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13. Grade Level: (Required.)

High School Senior

Freshman

Sophomore

Junior

Senior

Other (please specify)

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14. Current Major/Field of Interest: (Required.)

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15. Current GPA: (Required.)

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16. Are you currently on Academic Probation? (Required.)

Yes

I don't know

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17. If yes, what plan do you have in place to improve your academics?

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18. Please indicate who referred you to the fund (select one): (Required.)

Abbott Leadership Institute/College Success Center/Newark Grad Center

High School Academic Support Program

Leaders 4 Life

Other (please specify)

Application Questions

We want to understand your current challenges and the supports available to you. Please answer the following questions to the best of your ability to help us better understand the context of your current situation.

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19. Specify the exact amount of Emergency Funds Requested & What the funds are for($) (must have documentation to support) (Required.)

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20. Describe the current circumstance or challenge that brought on the emergency need for these additional funds. Please include details. Must attach proof of the need. (i.e., a bill, court order, payment plan, etc.) (Minimum 100 words, Maximum 250 words (Required.)

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21. What is your dream for your future? How will receiving this degree or certificate impact your life? (Minimum 100 words, Maximum 250 words) (Required.)

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22. Please describe what steps to resolve this current need. (For example - met with the financial aid office, requesting a payment plan, reaching out to family/friends, and job search) (Maximum 250 words) (Required.)

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23. How will these funds help you to successfully complete your school program and obtain your degree or certificate? (Minimum 100 words, maximum 250 words) (Required.)

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24. Do you anticipate having this challenge again? If so, please explain. (Required.)

Demonstrated Need: Emergency Fund Request

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25. Is this an emergency that requires money immediately (14 days or less)?
**Emergency Applications will be reviewed every 2nd Friday of the month. If there is an urgent need, email wholderefund@gmail.com after submitting.* (Required.)

Yes

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26. Attachment: Proof of Enrollment: Must include student name & number, name of institution and semster enrolled. (Required.)

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27. Attachment: Tuition Bill: Must include student name & number, name of institution and amount due. (Required.)

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28. Attachment: Attachment: Please Upload Proof of Emergency
Documentation must include the student’s name and any relevant supporting materials, such as but not limited to:
Eviction notice or letter from a landlord
Utility shut-off notice or overdue bill (electric, gas, internet, etc.)
Official death certificate or obituary for an immediate family member
Loss of scholarship or financial aid letter
Email notification about tuition balance changes or financial aid suspension
Medical bill, doctor’s note, or hospital discharge summary
Police report or incident report (in cases of theft, accident, or safety concerns) (Required.)

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29. Attachment: Please attach any other related documentation.

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30. I certify that in the information contained within this application is accurate to the best of my knowledge. If selected, I consent to the Wilhelmina Holder Fund Board use of my information or image for the purposes of contacting me or promoting the Fund's commitment to educational excellence and advocacy. (Required.)

I give my consent

I DO NOT give my consent

Thank you for applying for the Wilhelmina Holder Student Assistance Fund! Awards are announced by February 1st, June 1st, September 1st, and November 1st. If you indicated that this is an emergency request, we will be in contact with you within 30 days.

Students who are accepted will be contacted for updates and any additional documentation needed to process their award. You will receive a confirmation email once your materials are approved, along with next steps for receiving your disbursement.

If you have any questions in the meantime, please feel free to reach out to wholderefund@gmail.com.

WIlhelmina Holder Student Assistance Fund - Application

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* 1. First & Last Name: (Required.)

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* 2. Phone Number: (Required.)

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* 3. Email Address: (Required.)

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* 4. Home Address: (Required.)

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* 5. Are you a resident of Essex County or Greater Newark area? (If not, please do not complete this application) (Required.)

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* 6. Date of Birth: (Required.)

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* 7. Gender (select one): (Required.)

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* 8. Race: (Required.)

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* 9. Emergency Contact Name: (Required.)

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* 10. Emergency Contact Number: (Required.)

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* 11. Required: Post-Secondary School/Program Name: (Required.)

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* 12. Type of School/Program you are enrolled in (select one): (Required.)

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* 13. Grade Level: (Required.)

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* 14. Current Major/Field of Interest: (Required.)

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* 15. Current GPA: (Required.)

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* 16. Are you currently on Academic Probation? (Required.)

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* 17. If yes, what plan do you have in place to improve your academics?

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* 18. Please indicate who referred you to the fund (select one): (Required.)

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* 19. Specify the exact amount of Emergency Funds Requested & What the funds are for($) (must have documentation to support) (Required.)

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* 20. Describe the current circumstance or challenge that brought on the emergency need for these additional funds. Please include details. Must attach proof of the need. (i.e., a bill, court order, payment plan, etc.) (Minimum 100 words, Maximum 250 words (Required.)

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* 21. What is your dream for your future? How will receiving this degree or certificate impact your life? (Minimum 100 words, Maximum 250 words) (Required.)

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* 22. Please describe what steps to resolve this current need. (For example - met with the financial aid office, requesting a payment plan, reaching out to family/friends, and job search) (Maximum 250 words) (Required.)

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* 23. How will these funds help you to successfully complete your school program and obtain your degree or certificate? (Minimum 100 words, maximum 250 words) (Required.)

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* 24. Do you anticipate having this challenge again? If so, please explain. (Required.)

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* 25. Is this an emergency that requires money immediately (14 days or less)? *Emergency Applications will be reviewed every 2nd Friday of the month. If there is an urgent need, email wholderefund@gmail.com after submitting. (Required.)

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* 26. Attachment: Proof of Enrollment: Must include student name & number, name of institution and semster enrolled. (Required.)

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* 27. Attachment: Tuition Bill: Must include student name & number, name of institution and amount due. (Required.)

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* 29. Attachment: Please attach any other related documentation.

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1. First & Last Name: (Required.)

2. Phone Number: (Required.)

3. Email Address: (Required.)

4. Home Address: (Required.)

5. Are you a resident of Essex County or Greater Newark area? (If not, please do not complete this application) (Required.)

6. Date of Birth: (Required.)

7. Gender (select one): (Required.)

8. Race: (Required.)

9. Emergency Contact Name: (Required.)

10. Emergency Contact Number: (Required.)

11. Required: Post-Secondary School/Program Name: (Required.)

12. Type of School/Program you are enrolled in (select one): (Required.)

13. Grade Level: (Required.)

14. Current Major/Field of Interest: (Required.)

15. Current GPA: (Required.)

16. Are you currently on Academic Probation? (Required.)

17. If yes, what plan do you have in place to improve your academics?

18. Please indicate who referred you to the fund (select one): (Required.)

19. Specify the exact amount of Emergency Funds Requested & What the funds are for($) (must have documentation to support) (Required.)

20. Describe the current circumstance or challenge that brought on the emergency need for these additional funds. Please include details. Must attach proof of the need. (i.e., a bill, court order, payment plan, etc.) (Minimum 100 words, Maximum 250 words (Required.)

21. What is your dream for your future? How will receiving this degree or certificate impact your life? (Minimum 100 words, Maximum 250 words) (Required.)

22. Please describe what steps to resolve this current need. (For example - met with the financial aid office, requesting a payment plan, reaching out to family/friends, and job search) (Maximum 250 words) (Required.)

23. How will these funds help you to successfully complete your school program and obtain your degree or certificate? (Minimum 100 words, maximum 250 words) (Required.)

24. Do you anticipate having this challenge again? If so, please explain. (Required.)

25. Is this an emergency that requires money immediately (14 days or less)?
**Emergency Applications will be reviewed every 2nd Friday of the month. If there is an urgent need, email wholderefund@gmail.com after submitting.* (Required.)

26. Attachment: Proof of Enrollment: Must include student name & number, name of institution and semster enrolled. (Required.)

27. Attachment: Tuition Bill: Must include student name & number, name of institution and amount due. (Required.)

29. Attachment: Please attach any other related documentation.