First Name
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Last Name
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Date Of Birth
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Required Contact
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Required Contact
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Permanent Address
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City Name
State Name
Zip/Postal
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Name of College you are/will be attending
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Anticipated Year of Graduation College
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Anticipated Year of Graduation College
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Your Education costs:
Tuition $
Room, Board and Other costs
HighSchool Information:
Graduation year
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SAT Score
GPA (Senior Year High School)
Parent's information:
Father Name
Mother Name
Father's employer
Mother's employer
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father occupation
mother occupation
Parents Address (Only if different from your Primary Address)
City
State/Province
Zip/Postal
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Please be accurate a copy of last year family’s tax return, both returns if filing separately will be required for verification if applicant is chosen
List all those Excluding yourself, who will be dependent upon and supported by your parental income:
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Sources of Financial assistance and scholarships:
Family - $
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Federal aid - $
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State aid - $
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School - $
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Prior year ICC support - $
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Other - $
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Other income:
Stipends - $
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Other - $
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Number of siblings attending:
College debt:
Outstanding student loans - $
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Have you received any ICC support in the past?
When/How Much
List all awards, honors, scholarships and extracurricular activities you have engaged in
Write a Summary statement in support of your application including any special circumstances that should be considered
List all current community service, especially involvement in the South Jersey Indian Community
Personal Statement: Why we should consider your candidacy and how do you see community service unfold in your life story (Please limit your answer to less than 500 words)$
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Application Date
Required
Name of applicant required
Name of parent required