Ambassador Application - Fall 2015
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This document is an application for CUNY At Home in College Student Ambassadors. It requests contact information from applicants, including name, address, phone numbers and email. It asks for student information like high school attended, intended college and major. It contains questions about enrollment status, employment, citizenship and income eligibility. It provides 2015 poverty guidelines and allows applicants to describe themselves and why they want the position.
Ambassador Application - Fall 2015
- 1. CUNY At Home in College Student Ambassador Application Part I: Contact Information Name: _______________________________________________________________________________ Home Address: ________________________________________________________________________ Home Phone Number: ___________________________ Cell Phone Number: _____________________ Email Address: ________________________________________________________________________ Part II: Student Information High School: __________________________________________________________________________ College Attending in Fall 2015: ___________________________________________________________ Intended Major: _____________________ High School GPA (Please Attach Copy of Transcript:_______ Part III: Please circle YES or NO to the following questions: Are you enrolling in a full-time schedule? YES NO Are you currently working? YES NO Are you a citizen, resident alien, or do you have a visa that allows you to work? YES NO Does your family have a gross adjusted income under 200% of the federal poverty guidelines? (See chart on the following page) YES NO Do you have a bank account (for direct deposit purposes only)? YES NO Part IV: Tell us about yourself. _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ Part V: Briefly explain why you want this position. _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________
- 2. CUNY At Home in College Student Ambassador Application Income Eligibility Guidelines You are eligible to a Student Success Leader if your adjusted gross family income falls at or below 200% of the Federal Poverty Guidelines, which are updated annually by the United States Department of Health and Human Services (HHS). http://familiesusa.org/product/federal-poverty-guidelines. 2015 Poverty Guidelines Persons in family/household Poverty guideline 1 $23,540 2 31,860 3 40,180 4 48,500 5 56,820 6 65,140 7 73,460 8 81,780 For families/households with more than 8 persons, add $4,160 for each additional person. Acceptable Forms of Income Documentation: tax returns for the previous year, current pay stubs or earnings statement from employer(s), public assistance, unemployment, social security or disability award letters, child support cancelled checks or award letters, or dividend statements. In the event that an applicant does not have any of the above documentation, a notarized letter documenting family income source and amount may be submitted. Any change in family circumstances that impacted income since the prior year may be detailed in a letter. Examples of changes in circumstances include job loss by a major wage earner; divorce of parents or you from a spouse; birth or adoption of a child; death or disability of a major wage earner; loss of other income or benefits (such as Social Security or child support), by you, your parents or spouse.