Scholarship Form

Committed to Education

Child's Name *

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Grade *

We need a clear picture of your family’s income/expenses for the 2024 school year. Please complete this form so that we can better evaluate your eligibility for financial aid. Please be aware that total income includes: Income earned from work (whether or not a tax return was filed), Social Security benefits, AFDC (Aid to Families with Dependent Children), Support to the household expenses from other family members, unemployment benefits, child support, untaxed portion of pensions, Workmen’s Compensation benefits, support in kind (i.e. Military or Clerical living allowances). Please return this form with complete answers to the following questions within 14 days.

What is the total monthly income for the household? *

List other family members who are providing support to the household and the amount of that support:

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Amount of support provided? *

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Amount of support provided? *

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Amount of support provided? *

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Amount of support provided? *

What is the monthly cost of housing and utilities? *

What is the approximate monthly cost of food, clothing, car payment and maintenance, medical care, and medical insurance? *

Please be aware we may ask for proof of mortgage, rent receipts, utility bills, etc. We will hold your application for scholarship aid until we receive the above information. *

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