CLC Scholarship Request Form

CLC Scholarship Request Form

CLC scholarships are fulfilled to offset or fully fund the cost of tutoring and educational services provided by CLC for students grades K - 12.
Student Number (Internal Use)
Have you applied to a CLC scholarship in the past year?

I am applying to a CLC scholarship for the first time.I am reapplying to a CLC scholarship for a new year or because my financial information has changed.
Please note that the scholarship request form is broken into two sections: one is for you, the parent/guardian, to fill out and the other is for your student. The parent/guardian portion will ask about your/your student's financial and educational needs. The student request is just one open-ended question, and the response does not need to be lengthy, just honest.

Both sections must be submitted at one time, but if your student would like to get started while you gather your financial information, the student question can be viewed below. Please have your student answer the following question to the best of their ability. If your student requires, you may "scribe" or type while they talk. However, we are looking for genuine student responses, so please do your best to transcribe their thoughts as authentically as possible.

Student Request Question - "Why is coming to CLC important to you?"

Thank you!

Parent Scholarship Request

Please complete the following to the best of your ability. All required fields must be completed before continuing to the student request form.
If you are a CLC representative completing this form on the behalf of a family/student, please indicate your full name below:
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Email Address*
example@example.com
Parent/Guardian Phone Number*

Area CodePhone Number
Student Information
Student Name*

First NameLast Name
Student Age*
Student Grade Level*
What service does your student utilize or would your student like to utilize at CLC? **

After School TutoringTest PreparationCollege ConsultingHomeschool SupportCamp Limitless: Summer EnrichmentOther
How many hours of instruction per week do you anticipate that your student will utilize? *
Providing as much detail as possible, tell your student's story. How will your student benefit from these services, or why does your student need them? What would be the impact if your student is not able to access CLC services at this time?*
Please describe why coming to CLC is important to your student. How has your student been impacted by the services they have received or are currently receiving from CLC?

Add additional student
Student Name

First NameLast Name
Student Age
Student Grade Level
What service does your student utilize or would your student like to utilize at CLC?

After School TutoringTest PreparationCollege ConsultingEnrichmentHomeschool SupportOther
How many hours of instruction per week do you anticipate that your student will utilize?
Providing as much detail as possible, tell your student's story. How will your student benefit from these services, or why does your student need them? What would be the impact if your student is not able to access CLC services at this time?
Please describe why coming to CLC is important to your student. How has your student been impacted by the services they have received or are currently receiving from CLC?

End Section Collapse
Household and Financial Information

Number of family members who live in your household and/or you are financially responsible for?*

	Number
Children
Adults
Total Family Members

What is your total annual household income?*

$0 - $20,000 per year$20,000 - $40,000 per year$40,000 - $60,000 per year$60,000 - $80,000 per year$80,000 or more per yearOther
Does your student qualify for free or reduced lunch? (Please note that in order to receive 100% funding, we may request proof that you qualify for free or reduced lunch or a copy of your previous year's income taxes).*

YesNoUnsurePrefer Not to Disclose
Describe your household's employment and/or financial situation.
Do you rent or own your home?*

RentOwnOther
Estimate your total housing costs per month (rent/mortgage + HOA fees + utilities).*
Estimate your other total fixed household costs per month? (Legally contracted payments only: loan payments, child support, car payments, student loans/tuition, etc, NOT including your housing costs from above. Do not include groceries, dining out, entertainment, activities, etc.)*
What is your total monthly household income? *
What is your monthly household income after expenses?*
Do you have access to/own a car?

YesNoI share a carI take the busOther
Is there any additional financial or household information that would help us understand your situation? This can include how COVID-19 has affected your family.
Every year, scholarship requests from students exceed the available funding. Our goal is to extend funding to as many families as possible. Please note, all requests are taken into account on a per semester basis, and we may award scholarships at a different funding level or hourly amount than requested.
Please indicate the level of funding you are requesting. Our standard rates for tutoring K-12 are $75/hr. Our standard College Level and Test Preparation Rates are $100/hour. Our standard College Consulting rates are $135/hour.*

In order to access services, I request 100% funding. (Please note that in order to receive 100% funding, we may request proof that you qualify for free or reduced lunch or a copy of your previous year's income taxes).In order to access services, I request 75% funding.In order to access services, I request 50% funding.In order to access services, I request 25% funding.Other
Optional: If you would like to upload proof of free or reduced lunch or a copy of your previous year's income tax to support your request, please do so here. If not provided at this time, CLC may request these documents in order to assess your scholarship application.

Browse Files

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As a reminder, all information collected on this form is confidential and will not be shared outside of Colorado Learning Connections.
Please review and save the following procedures and guidelines for your reference.
I, {parentguardianName}, affirm that*

All information submitted in this application is accurate.
I, {parentguardianName}, affirm that*

I have read and understand the above procedures and guidelines.
I, {parentguardianName}, affirm that*

My survey data and feedback may be anonymously utilized by CLC to help improve services and acquire funding.
Parent signature*

Clear
Prior Form Questions
I certify that my financial information has not changed since my previous application.

Yes, my financial information has not changed.No, I need to update my financial information for this application or this is the first time I am applying.
Please describe how your financial needs/information have changed. Please include changes to you/you immediate families' employment, housing costs (rent or mortgage), monthly debt liabilities (car payments, student loans, etc - does not include housing), and income.
There is no student request required for scholarship reapplication. If you or your student have any additional thoughts or information, please share it below:

Student Scholarship Request

For STUDENT to complete: Please answer the following to the best of your ability. If you would like, your parent/guardian may "scribe" or type while you talk, or help with your spelling and typing. But, most importantly, we just want to hear what you have to say.
As a student, why is coming to CLC important to you?*
Recommendation/notes from director
Should be Empty:

CLC Scholarship Request Form

Parent Scholarship Request

Student Information

Household and Financial Information

Prior Form Questions

Student Scholarship Request