Puerto Ricans Organized Overseas in Florida, Inc.
2555 Collins Ave. - Suite 1402
Miami Beach, Florida 33140
STUDENT INFORMATION
Name: _______________________________________________________________________________________
First
Middle
Social Security #: ____/____/_______
Last
Date of Birth: ________________________________________
Address:___________________________________________________________________________________
City: _____________________
State: ______________
Home Phone #: _____________________________
Zip Code: _____________________
Work #: ____________________________________
Cell #: _____________________________Email: __________________________________________________
Age: _____________
Marital Status: ________________
# of Children (if any): ___________________
Place of birth: ___________; Parents’ place of birth: __________; Grandparents place of birth:____________
Spouse Name (if applicable): _____________________________________________________________________
Number of family members, including applicant, living at home: ______________________________________
Number of other children, including applicant, in college: __________________________________________
Parent/Guardian Information
Parents’ Marital Status:
Married ________ Divorced _________ Single ________
Widower ______Separated _______ Re-Married ________
Father’s Name: ____________________________________________________________________________
First
Middle
Occupation: _______________________________
Last
Employer: ______________________________________
Mother’s Name: ___________________________________________________________________________
First
Middle
Occupation: __________________________________
Last
Employer: ________________________________
Amount of Taxes Paid in the year 2011: ____________________
Total Savings: __________________
Earned Income Credit: _______________________________________________________________________
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Puerto Ricans Organized Overseas in Florida, Inc.
2555 Collins Ave. - Suite 1402
Miami Beach, Florida 33140
HIGH SCHOOL INFORMATION
Name of school: _________________________________________________________________________
Address: _______________________________________________________________________________
Phone #: ____________________________ GPA: _________ Do you speak Spanish? Yes ____ No___
*Special Awards, honors, etc., earned or received; and leadership positions held:
_________________________________________________________________________________________
_________________________________________________________________________________________
* Hobbies and other Interests: _____________________________________________________________
_________________________________________________________________________________________
If you have additional information, please attach a sheet indicating same.
COLLEGE INFORMATION
Major you will be pursuing: _______________________________________________________________
College or University you plan to attend: ___________________________________________________
Beginning Date: ____________________________ Semester: ___________________________________
College Address: _________________________________________________________________________
City: _____________State: _______ Zip Code: ____________ Phone #: ___________________________
Total tuition and other expenses for full academic year: ___________________________________ __
Cost of tuition per credit:__________________________________________________________________
How many credits per semester will you be taking:__________________________________________
Have you been admitted?
Yes: _______________________
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No: _____________________
Puerto Ricans Organized Overseas in Florida, Inc.
2555 Collins Ave. - Suite 1402
Miami Beach, Florida 33140
FINANCIAL RESOURCES
Source:
Amount Granted:
Student Loan
Student Grant
________________
________________
Scholarships Approved, Awarded and/or Received:
1) __________________
________________
2) __________________
________________
3) __________________
________________
Other Financial Resources (include savings accounts, real property or other assets)
Acknowledgement
I, _______________________, hereby acknowledge that the foregoing information is true and correct to the
best of my knowledge, and I promise to abide by the rules of PROOF’s Scholarship Award Program.
I understand that if granted this scholarship, I will provide proof of registration before the check can be
forwarded to my college or university of choice.
_____________________________
Applicant’s Signature
_________________
Date
__________________________________________________________________________
Mail or E-Mail to:
PROOF President / 2555 Collins Ave., Suite 1402, Miami Beach, FL 33140
hrcmd8@bellsouth.net
Remember!
Must be postmarked no later than Monday, July 31, 2014
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Puerto Ricans Organized Overseas in Florida, Inc.
2555 Collins Ave. - Suite 1402
Miami Beach, Florida 33140
REQUIREMENTS
The Ivonne Belaval Scholarship Award is issued each year by the organization Puerto Ricans Organized
Overseas in Florida Inc. [PROOF] to young Puerto Ricans (native or descent) who enter their first year of
undergraduate studies, at a university or college; have a minimum GPA average of 3.5 or higher;
demonstrate an unmet financial need; and, in addition, have achieved outstanding academic
accomplishments.
To be considered for this Scholarship, all documentations listed below must be completed and submitted by
July 31, 2014, to the address indicated on the cover page of this application. Failure to do so could
disqualify the applicant.
Check List:
______
Fully completed Application Form.
______
IRS Income Tax Return for the year 2012 (parents’, if a dependent) or proof of income for
applicant and/or parents (include spouse, if applicable).
______
Applicant’s official school transcript.
______
Proof of being Puerto Rican or of Puerto Rican descent (such as birth certificate)
______
A written statement by the student indicating his/her professional goals.
______
A short essay written by the student on “What it means to be Puerto Rican”.
______
Photo of your choice (2” x 2”). If selected this photo will be used in the program and will not
be returned, so please send duplicate.
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