Inquiry Form

Family Economic Security Program (FESP)

If you are interested in participating in FESP, or just want more information, please fill out the form below. We will get back to you!

Please complete the questions below to be considered for FESP- Family Economic Security Program. FESP is a one-year program that starts in January 2024 through December 2024. The program is designed to help YOU persist at CT State Housatonic. Students are provided with financial supports, campus resources and connections, learning opportunities, and financial literacy to help you balance school/work/family life so that you stay on track and move closer to obtaining your degree. Applications are due December 29

Tarena Gadsden will be contacting you around January 12th, you will receive an email with the status of your application.

(203)332-5201

Today's Date

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What is your 8-digit Banner ID (*)

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First Name(*)

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Last Name(*)

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College Email(*)

@CTstate.Edu

Phone Number:(*)

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Home address with city state and Zip (if you are in protection, dont complete)

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Privacy Notice and Consent:

CT State Housatonic is committed to your success, including securing your personal information and maintaining your privacy when we collect personal information. If you apply for a scholarship, the Housatonic Foundation (“We”) will only use your application information for the purpose of determining scholarship eligibility and administering scholarship benefits if awarded. If you are selected as a scholarship recipient, we may disclose your name, GPA, and information from your personal statement to Housatonic Foundation donors (“Donors”) for the purpose of relaying the value of their contributions to the Housatonic community. We may also include your name, photograph, if applicable, and personal statement in the annual report for the purpose of informing the broader community about your success. To administer scholarship payments, we will provide your name, Banner ID, and e-mail address so that scholarship benefits can be accurately distributed. By submitting this scholarship application, you are providing official consent for your personal information provided as part of the application to be used for the purposes described in the privacy notification.

Consent to Determine Financial Need:

I consent to the disclosure of limited information from my educational record to the Housatonic Foundation, Inc. (“the Foundation”) from CT State Housatonic (“the College”). This disclosure shall include a determination if I have filed a FAFSA with the college, my expected family contribution, my financial aid award information from federal, state, institutional, and other sources, and my charges for tuition and fees related to my attendance at the college. I understand that this information will be used for the limited purpose of the Foundation, which is to review my scholarship application materials and make a determination as to my eligibility for an award from the Foundation. I understand that my consent to the disclosure of the aforementioned information from my educational record is valid only for the current academic year.

Acknowledgment

I understand that funding associated with my financial aid package will be used before I receive additional funding and that funding is not transferrable to other CT State campuses. Balances will not be paid out.

I confirm that I read the above privacy and consent(*)

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Please select your GPA(*)

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How many credits do you currently have?(*)

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REQUIRED: a PDF of your latest/complete transcript (from DegreeWorks). (*)

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STEPS: Log In (ctstate.edu) Home /Student Self Service / access Degree Works / Screen will say "Program Audit" / GO TO the TOP RIGHT of the internet screen / CLICK the Options OR three dots (...) / CLICK PRINT / PRINT AS PDF, Save the file and Upload NOT ACCEPTED: Photos, JPGs, PNGs, screenshots, and Word documents (You need to convert these to PDFs, by clicking PRINT AS PDF. ) *An Incomplete Transcript will result in your application being declined.

What is your relationship status?(*)

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Are you a parent?(*)

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How many children do you have(*)

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What is your yearly income per Year (AGI)?(*)

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Select your current work status:(*)

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If you did not select unemployed above, what is your Job title or job?

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How many members in the family Household are employed?(*)

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If others work, what is their approximate Incomes for each?

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Do you have insurance?(*)

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If yes, please fill in your insurance provider's details. Husky

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Do you have any unpaid loans?(*)

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If yes, please input estimated total debt amount on all unpaid loans?

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Have you ever gotten government assistance through the relief fund before?(*)

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If yes, what is the reason that you need the relief funds? Education, Household, other

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What are you monthly amount of relief funds open?

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How do you identify? (*)

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Ethnicity and Race(*)

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Please type any questions and/or comments below.(*)

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I confirm that I have entered truthful and accurate information, that I have read and understand the privacy and consent information on the first page of the application, i understand the criteria to join the FESP Program, the guidelines and stipulations to continue in the FESP Program if I am selected, and CT State Housatonic is my home campus and I will be taking the majority of my classes at the CT State Housatonic campus.(*)

You will receive an email confirming that your application has been received. MAKE SURE TO CHECK YOUR COLLEGE EMAIL'S JUNK FOLDER.

To stop emails from going to your college junk email folder, right click on the email, scroll down to junk and select "Never Block Sender Domain"

I confirm that I have entered truthful, and accurate information, and understand and agree to all the information within this application(*)

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Enter the text for security reasons.(*)

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