The deadline for submitting applications for the following school year is May 1 each year. Kids Chance Application Please fill out this application as completely as possible. All fields are required, if applicable. Please note that the student must be an Alabama resident. * indicates required fields to submit form online Step 1 of 5 - Student Information 20% Name First Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Home Telephone Number*Parent's Email* Applicant's Email* Applicant's Cell Phone NumberDate of Birth* Social Security Number* Parent's Names*Number in household*How many of these are minor children?*Injured or deceased parent:Name First Last Date of Injury Date of Death Name, address and telephone number of employer or former employerWorkers' compensation insurance carrier of employerName, address and telephone number of parent's lawyer or insurance adjusterIs other parent employed?YesNoName and address of employer Name and address of high school attendedFor potential technical school or college studentsA. Names and addresses of schools applied toB. If you have been accepted for admission, please name the school(s). Tell us which school you plan to attend. Major field of intended study and date you expect to graduate from college or trade school:Career objectiveHow do you plan to finance your education?List sources and amounts of income including Prepaid Affordable College Tuition Program (PACT), loans, grants, scholarships, employment, savings and parental or family contributions.Do you plan to live at home or on campus?If you will be employed during the regular school year please specify the type of work and the approximate number of hours per week:Other circumstances which you feel the Kids' Chance Committee should know in reviewing your scholarship request: Household IncomeMonthly AverageWorkers' Compensation PaymentDisability InsuranceIncome of other parent (Gross)Additional income of other dependents of injured or deceased employee residing in the same household with applicant. Please itemize.List income one per line.Financial assistanceFinancial assistance from any state or federal agency, such as welfare.Child support paymentsChild support payments received on behalf of children residing in same household with applicant.SSIOther incomeTotal Monthly IncomeHousehold AssetsValue of AssetsCash on hand or in banksStocks, bonds, notesReal EstateHomeOther Real EstateAutomobilesOther Personal PropertyList one per line.Total AssetsHousehold LiabilitiesBalance OwedCredit Union or BankReal estate mortgageAutomobile loansOther notes or loansOther billsList one per line.Total Liabilities Additional Documents Required 1. High School transcript of grades. You do not need to submit high school transcripts if you have already graduated from high school and are currently attending college. 2. College or technical school transcripts if currently enrolled. If you are on the semester system, please have your school send a transcript directly to the foundation following the end of the spring semester. 3. Copy of financial aid letter from the school you will be attending. The scholarship committee expects all eligible applicants to apply for financial aid in addition to the Kids' Chance Scholarship. It is important to apply early. See the next page for tips. 4. Letters of recommendation (optional). 5. Please provide proof that parent has been found permanently and totally disabled from an on the job injury. For example, a copy of a court order or statement from the workers' compensation insurance carrier. A doctor's statement or Social Security Administration statement are not sufficient. 6. Death Certificate of deceased parent (if applicable). Death must have occurred as the result of an on the job injury. 7. Please attach a brief description of the accident. 8. Copy of last year's tax return of parent or guardian. The first page showing adjusted gross income is sufficient. Please list the names of all persons who assisted the applicant in preparing this document.List one per line. The amount of each Kids' Chance Scholarship awarded is decided by the Scholarship Com¬mittee. Scholarships have traditionally ranged from $500 to $3,000 in amount. No scholarship will exceed the annual cost of tuition and books at the most expensive in-state public univer¬sity. The deadline for submitting completed applications and supporting documents for the upcom¬ing school year (beginning in August or September) is May 1 of each year. Applications must be received in the foundation's office by May 1, and will not be accepted after the deadline. Scholarships will be awarded in late June or early July. Please send to: Kids' Chance Scholarship Committee Alabama Law Foundation, Inc. Post Office Box 4129 Montgomery, Alabama 36103 (334) 387-1600 CERTIFICATION AND AUTHORIZATIONIf you are submitting an application online, please print and sign the Certification of Authorization. You will be prompted after submission. Mail the signed copy along with other required documents to: Kids’ Chance Scholarship Committee Alabama Law Foundation, Inc. Post Office Box 4129 Montgomery, Alabama 36103 (334)387-1604 Click here to download the Certification of AuthorizationCommentsThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle AJAX powered Gravity Forms.