2012-2013 Scholarship Application

STUDENT INFORMATION

* First Name

* Last Name

* Date of Birth:

* Who has custodial rights of this child?

* With whom does the child reside?

* For which class are you applying your child?

PARENT INFORMATION

* Parent First Name (List both parents if residing at same home)

* Parent Last Name

* Current address:

* City:

* State:

* Zip Code:

* Mother's Email address:

* Occupation:

Mother's Employer:

* Father's Email address:

* Occupation:

Employer:

Please enter parent information if separate residence from above

Parent first name

Last Name

Current address (if different than above):

City:

State:

Zip Code:

Home phone number (if different than above):

Cell phone number:

Email address:

Occupation:

Employer:

FINANCIAL INFORMATION

* Please list the amount of family income from all sources:

* Please briefly describe the reasons for needing financial aid:

* How much of the annual tuition are you able to pay? List specific amount.

* Please list cash assets:

* Please list Stocks and Bonds assets:

* Please list real estate assets:

* Please list real automobile assets:

* Please list CDs, Money Market Account assets:

* Please list morgatge liabilities you may have:

Please list your annual expenses:

* Mortgage or Rent- please specify:

* Utilities:

* Groceries:

* Insurance:

* Child Care:

* Other Tuition payments:

* Loans:

* Taxes:

* Cost of Clubs Requiring Dues:

* Vacation Costs:

* Cost of Clubs Requiring Dues:

* Other Expenses:

A copy of page 1 and 2 from your most recent federal income tax return must be attached in order for your application to be considered. You may also bring a hard copy to the preschool office.

SCHOLARSHIP APPLICATION AGREEMENT

I understand that the information contained in this application is provided for the purpose of obtaining financial assistance from First Presbyterian Preschool for tuition. I (we) understand that you are relying on this information and a copy of our most recent tax return in order to determine whether to grant financial assistance and the amount of financial assistance, if any. I (we) represent and warrant that the information provided is true and complete.

* Electronic Signature

* Date

* Indicates Response Required