KBC Sholarship Form

Name*

First NameLast Name

Male / Female*

MaleFemale

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Birthday*

MonthDayYear

Phone Number*

Area CodePhone Number

Email*

example@example.com

Are you applying for assistance with payment of Coaching or a Course?*

CoachingCourseBoth

In one paragraph, please state "Why I am interested in participating in KBCoaching or KBCourses?*

Please make a brief statement describing why you are in need of financial assistance. *

What is your occupation / job title? *

What is spouse's occupation? *

What is the combined/total annual household income: Check the appropriate box. *

	Under $20,000	$20,000-$30,000	$30,000-$40,000	$40,000 and Up
Income

The amount of assistance is based off a rolling tier.

The items listed below are to be transferred from your 1040: (Includes spouse's information is applicable).

Number of Dependents*

Line 6C on 1040, Line 5on 1040 EZ or Line 6C on 1040A.

Adjusted Gross Income*

Line 37 on 1040, Line 4 on 1040 EZ or Line 21 on 1040 A.

Total Income*

Line 22 on 1040 or Line 15 on 1040 A.

List Special Circumstances (If Any)

By signing this document, I agree that the information is accurate.

Print Name*

First NameLast Name

Signature*

Please Note: Financial assistance is not guaranteed. It will be determined based on the viability of your application. Assistance will be given based on the availability of funds and level of need.

Please write a descriptive account of why you are in need of financial assistance.

This application is confidential. The information on the form will not be disseminated.

Our financial assistance committee will meet once a month to allocate funds. the committee will allocate the funds received from our Scholarship Fund and/or our generous Sponsors until they are diminished.

We will notify applicants of the award amount within 2/4 weeks.

Need is the most important priority in awarding our scholarship.

2023 Scholarship Application