Do you live alone with your children in your home? Yes No
Number of other children household:
Number of other adults household:
Do other adult family members work? Yes No
Does this student qualify for free or reduced lunch through a School District? Yes No
Household Gross Income ('08 or '09 tax form):
Entire Household gross income for all adults (current monthly income):
Child support amount (if applicable):
When are you available to volunteer: Weekdays Weekends Mornings Afternoons Evenings
Use the space below to let us know about any unusual circumstances or other information regarding your need for tuition support. All requests are confidential.
The information on this form is true to the extent of my knowledge. I understand that documentation of income must be turned in with this application before any decision will be made. I agree to the conditions stated on the information and instruction sheet and agree to commit to completing the full semester and paying my portion of tuition as scheduled. Furthermore, I understand that if information on this application is found to be false or I do not follow the conditions as stated, the scholarship will be withdrawn.
