Please type or print clearly. Forum Username: ____________________
Personal Information
Full Name: _____________________________________________ Gender (M/F) __________
First Middle Last
Address ________________________________________________________________________
________________________________________________________________________________
List Street, City, State and Zip Code
Home Telephone: ________________________ Work Telephone: _______________________
Facsimile ______________________________ Cell Phone: ___________________________
Citizenship: ______________________________ Social Security Number: ____________
Date of Birth: ________________ E-mail address: ________________________________
Driver License No. : ________________________ Marital Status: (S/M/D)___________
Is English your primary language? _____ If no, what language ___________________
Do you have any health considerations that may affect normal work routines? ____
If so, what are they? __________________________________________________________
Attach additional information if necessary.
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Are you currently attending a culinary school? ____ If so, provide the
Name: __________________________________________________________________________
Address: _______________________________________________________________________
Contact: ______________________________________ Telephone: _____________________
Length of program? _____________ Enrollment Date: Month:___ Day:___ Year:_______
Full time or Part Time: _________________ Expected Completion: _________________
Expected Degree or Certificate: ________________________________________________
If not in culinary school, have you applied? ______ When: ______________________
Have you been accepted? ____________ Is your application Pending? ______________
If Yes or Pending, provide the details below.
Name: __________________________________________________________________________
Address: _______________________________________________________________________
Contact: ______________________________________ Telephone: _____________________
For what term are you applying: ________________________________________________
________________________________________________________________________________
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Scholarship/grants you have applied for OR received. List Dates and Amounts.
________________________________________________________________________________
________________________________________________________________________________
Attach additional information if necessary.
Are other funds available to you for your tuition and have you made arrangements
to receive them? What are they and in what amount? _____________________________
If not in culinary school, are you a student? If so, please provide the details.
Name: __________________________________________________________________________
Address: _______________________________________________________________________
Contact: ______________________________________ Telephone: _____________________
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Educational History beginning with High School: (will be used as references)
School: ________________________________________________ Date Graduated: _______
City/State/Phone: ______________________________________________________________
Degree/Diploma/Certificate received: ___________________________________________
School: ________________________________________________ Date Graduated: _______
City/State/Phone: ______________________________________________________________
Degree/Diploma/Certificate received: ___________________________________________
School: ________________________________________________ Date Graduated: _______
City/State/Phone: ______________________________________________________________
Degree/Diploma/Certificate received: ___________________________________________
Attach additional information if necessary.
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Apprentice and Work History (will be used as references)
Company: ________________________________________________ Contact : ____________
City/State/Phone: ______________________________________________________________
Start Date: ___________ End Date: _____________ Position: ______________________
Company: _ ______________________________________________ Contact : ____________
City/State/Phone: ______________________________________________________________
Start Date: ___________ End Date: _____________ Position: ______________________
Attach additional information if necessary.
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Applicant’s Financial Statement:
Income Tax Year (from last return): ________ Occupation: _______________________
Dependents claimed: ___________ Type of return: Individual or Joint? ___________
If married & filed individual, you must add the totals from your spouse's return.
From Form 1040, Line 22. Your total Income $____________________________________
Total Interest, Royalties or Rents received: ___________________________________
Total Interest Paid: _____________ I own _______ rent/lease ______ my residence.
Total value of bank accounts and investments $__________________________________
Value of other assets or investments, describe $________________________________
Note: If you did not file a tax return or your parents claimed you as a deduction, you must complete the Parent's Financial Statement below. If your parents are married and filing separately or if your parents are divorced, you must combine
the income and assets of both parents. We may require your parents and/or step-parents to sign documents so that we may obtain information on their tax return.
Parents’ Financial Statement (if required)
Parents marital status: Mother: _________________ Father: ___________________
If a step-parent is a custodial parent, include step-parents’ income in the parents section.
Name: ______________________________ Age: _____ Occupation: ____________________
Father/Stepfather
Name: ______________________________ Age: _____ Occupation: ____________________
Mother/Stepmother
Address: _______________________________________________________________________
Street City State Zip
Home Telephone: ________________________ Work Telephone: _______________________
Email Address: _________________________________________________________________
Total Annual Income from all sources $ __________________ $ __________________
Father/Stepfather Mother/Stepmother
Last year in which your parents filed a Federal income tax return: _____________
Total Interest, Royalties or Rents received: ___________________________________
Total Interest Paid: _____________ I own _______ rent/lease ______ my residence.
Total value of bank accounts and investments $__________________________________
Value of other assets or investments, describe $________________________________
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One Personal Reference
Please list one personal reference who is not a family member, professional or educational reference:
Name: ________________________________Relationship: ____________________________
Years known: ________________________ Telephone: _______________________________
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An Essay about your Culinary Plans (REQUIRED)
Please state your culinary goals and how a culinary grant would affect your culinary goals in an essay of 500 words and submit it with this application.
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Authorization, Affirmation and Certification
You herewith give us permission to confirm your enrollment status with the school
by phone or mail. You also understand that we may require you to sign additional
documents to obtain information on your income tax return, credit and/or any
personal information.
You understand that this application does not in any way guarantee the receipt of a grant. It is an application that can be accepted or denied at our option. If your application is accepted for consideration in writing, it does not in any way guarantee the receipt of a grant. You agree that you abide by our final decision and that you have no recourse to contest it.
If you completed the Parent's Financial Statement, we may require your parents and/or stepparents to sign documents so that we may obtain information on their tax return.
To the best of my knowledge, all information I have provided in my application is accurate and true.
Signature: ______________________________________________ Date: ________________
Applicant
If you completed the Parent's Financial Statement, we also need your parents to sign this certification.
Signature: ______________________________________________ Date: ________________
Mother/Stepmother
Signature: ______________________________________________ Date: ________________
Father/Stepfather
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Mail this completed application to:
Chef2Chef, LLC,
Attn. Culinary Grant Application
1360 Indian Trail No. 13
Steamboat Springs, CO 80487
Application Deadlines: All applications must be received 6 weeks prior to the the announcements dates of April 1st and October 1st in each calendar year.
The culinary grant is the sole promotion of Chef2Chef, LLC and is not affiliated with any other person or entity including any culinary school or its agents.
Revised 11/04/2009