Blue Bear Foundation Funding Application You may download the application and mail or email it in. Or you may fill it out online and submit... If you are a human and are seeing this field, please leave it blank. Fields marked with an * are required I affirm that I plan to pursue a career so I can improve myself and my community. I give permission to officials of my institution to release transcripts of my academic record and other information requested for consideration in the Blue Bear Foundation program. I understand that this application will be available only to qualified people who need to see it in the course of their duties. I waive the right to access letters of recommendation written on my behalf. I affirm the information contained herein is true and accurate to the best of my knowledge and belief. By typing my name I agree that this represents my signature: * * Last Name * First Name * Middle Initial * Date of Birth * Age * Race/Ethnicity: Check one. If you are multiracial, you may select two or more races. American Indian or Alaska NativeAsianBlack or African AmericanHispanic/LatinoNative Hawaiian or other Pacific IslanderMultiracialWhite/Caucasian Check One * I am a U.S. CitizenU.S. NationalResident Alien (With Green Card or expecting citizenship) Military Record * Air ForceArmyCoast GuardMarinesNavyNo Military Service Dates of Service: From: To: Still Serving Current/Final Rank Honorable Discharge * YesNo Dishonorable Discharge * YesNo If Dishonorably Discharged, please provide an explanation: Permanent Address * Address 2 City * State * Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip / Post Code * Home Phone/Cell * Cell Phone/Alternative Email * School/University Name * Address 1 * Address 2 City * State * Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip / Post Code * Country Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua And Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia And Herzegowina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, The Democratic Republic Of The Cook Islands Costa Rica Cote D'Ivoire Croatia (Local Name: Hrvatska) Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Timor-Leste (East Timor) Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France France, Metropolitan French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard And Mc Donald Islands Holy See (Vatican City State) Honduras Hong Kong Hungary Iceland India Indonesia Iran (Islamic Republic Of) Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea, Democratic People's Republic Of Korea, Republic Of Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macau Macedonia, Former Yugoslav Republic Of Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated States Of Moldova, Republic Of Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Kitts And Nevis Saint Lucia Saint Vincent And The Grenadines Samoa San Marino Sao Tome And Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia (Slovak Republic) Slovenia Solomon Islands Somalia South Africa South Georgia, South Sandwich Islands South Sudan Spain Sri Lanka St. Helena St. Pierre And Miquelon Sudan Suriname Svalbard And Jan Mayen Islands Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania, United Republic Of Thailand Togo Tokelau Tonga Trinidad And Tobago Tunisia Turkey Turkmenistan Turks And Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Venezuela Viet Nam Virgin Islands (British) Virgin Islands (U.S.) Wallis And Futuna Islands Western Sahara Yemen Yugoslavia Zambia Zimbabwe List High School(s) (or GED info): High School/GED Program — Address — Graduation Date List College(s)/Certificate Programs: College/Certificate Program — Address — Graduation Date List college and high school activities (student government, sports, publications, school-sponsored community service programs, student-faculty committees, arts, music, etc.): Activity/Group — Title/Participation Level — Date(s) List public service and community activities (homeless services, environmental protection/conservation, advocacy activities, work with religious organizations, etc.): Activity/Group — Title/Participation Level — Date(s) List government activities (internships with government agencies, partisan political activities, ROTC/military, municipal boards and commissions): Activity/Group — Title/Participation Level — Date(s) List part-time and full-time jobs and nongovernment internships since high school graduation. Activity/Group — Title/Participation Level — Date(s) Applicant's Income 0 - $15,000 / yr$15,000 - $25,000 / yr$25,000 - $35,000 / yr$35,000 - $45,000 / yr$45,000 - $55,000 / yr BASIC NEED CALCULATION Use the following format to provide the information requested. Budget for tuition, fees, books, supplies Current Academic Year — Next Academic Year Other Financial Needs Current Academic Year — Next Academic Year Applicant’s scholarships, grants, and other awards Current Academic Year — Next Academic Year Other Sources of Income Current Academic Year — Next Academic Year Support System: Please briefly describe your immediate family dynamic: * Career Goals: Attach 1 paragraph detailing your greatest achievement so far and 1 paragraph detailing what you believe will be your greatest achievement in the future. Indicate how your studies in accounting/finance relate to the overall achievement of your objectives. * REFERENCES Please provide a two or three references on character and leadership potential. Textarea Name — Relationship — Contact Info