Tuition Assistance Application

Name of Adult (Head of Household) *

First

Last

Home Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Email *

Which Season Are You Submitting This Request For? *

What is the household income PER YEAR (before taxes?): *

What is the household income PER MONTH (before taxes?): *

What is the household income PER WEEK (before taxes?): *

Number Of People In Household *

Are you currently receiving any other form of Financial Assistance? *

If Yes, Please Explain

Amount Requesting: $ *

Toward Tuition fee of: $ *

Student's Name *

First

Last

Student's Age:

Title of Class / Workshop

Held at:

Other Information/Special Circumstances

Notification *

Notification about awards will be sent out via mail or e-mail. Preferred method of communication - please check one.

SIGNATURE *

I certify that, to the best of my knowledge, all of the information listed above is accurate and all income has been reported.

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