Tuition Assistance Application Fall/Spring 2020-21 (Blended)

Tuition Assistance Application Fall/Spring 2020-21 (Blended)
FAMILY INFORMATION
New Student Returning Student
Name(s) of Student(s)
Parent/Guardian Name
Relationship to Student(s)
Street Address
APT#
City
State
Zip Code
Cell phone number
Home/Work number
E-Mail Address *
example@example.com
Employer's Name
Annual Salary
2nd Parent/Guardian Employer's Name
Annual Salary
STUDENT INFORMATION
Student(s)
Age(s)
Class(es) Applying for Tuition Assistance
CURRENT HOUSEHOLD INCOME SOURCES
Please Upload Proof of Current Household Income Sources (black out Social Security #) *

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If you having trouble please contact arodriguez@mind-builders.org Cancel of
Employment Wages
Unemployment Benefits
Public Assistance Benefits
SSI/Disability Benefits
Child Support Benefits
FAMILY TUITION PAYMENT
Total household income per month *
Number of adults living in household
Number of youth living in household
Please explain any other factors that affect your ability to pay
How much monthly tuition can you afford? *

Tuition Assistance Agreement Fall/Spring 2020 (Blended)
If Tuition Assistance is granted for my child(ren), I understand and agree that: (Please initial below)
I will be responsible for all tuition fees not covered by my award.
I will maintain my payment schedule.
I will be responsible for making certain that my child attends regularly.
(More than 3 absences will lead to review of tuition assistance and possible termination.)

Waiting list procedure: When all available tuition assistance has been awarded, remaining T.A. applicants are placed on a waiting list. The School will continue to accept applications with the expectation that additional funds may become available throughout the year.

I hereby affirm that the information contained in this application is true and correct. If my financial circumstances change, I will notify Mind-Builders Creative Arts Center. In the event that it is determined that any of the statements in this application are not true or not correct, any amount granted as tuition assistance will be immediately deemed to be a debt and payable by me to Mind-Builders Creative Arts Center.
Guardian/Parent Signature

Clear
Date

Month Day Year
Date
Co-Applicant Signature

Clear
Date

Month Day Year
Date
Should be Empty: