FWMSH Little Scholars Program Scholarship Application 2020

FWMSH Little Scholars Program Scholarship Application 2020
STUDENT INFORMATION * Please list all children applying for a scholarship.
Name *

First Name Last Name
Age *
Grade *
Gender *

Female Male
Name

First Name Last Name
Age
Grade
Gender

Female Male
Name

First Name Last Name
Age
Grade
Gender

Female Male
Parent Information:
Parent/Guardian #1 Information *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number *

Area Code
Home or Cell Phone *

Home Phone Cell Phone
Email
example@example.com
Employer *
Parent/Guardian #2 Information

First Name Last Name
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number

Home Phone Cell Number
Home or Cell Phone

Home Phone Cell Phone
Email
example@example.com
Employer
Total number of children living in the household? *
Total number of adults living in the household? *
What is your monthly gross income? (Before taxes and deductions) *

$ Parent/Guardian #1 $ Parent/Guardian #2
Do you currently receive public assistance? *

No Yes
If yes, what type?
(Medicaid, TANF, SNAP, Texas WIC, etc.)
If you are not on public assistance – You must send proof of income – copies of either your 2019 tax return OR paychecks that show a gross monthly amount.
Do you receive any other household income? *

No Yes
What kind?
(child/spousal support, unemployment, pension, student grants, etc.)
Monthly Gross Income from this source $____________
Please give us additional information that will assist with the scholarship decision. *
The information I have provided is correct. I understand that all information is kept strictly confidential and has been requested for the sole purpose of establishing financial need. I have read and understand the requirements regarding scholarship awards and have attached the required income documentation.
Signature *

Clear
Date *

Month Day Year
Date
Should be Empty: