EPIC Homeschool Academic Studies Scholarship Application Form

EPIC Homeschool Academic Studies Program Award gives a student money to go towards classes and clubs offered in the Academic Studies Program. The money gets paid directly from the center to the programs and is not given to the student directly.

Parent Name *

First Name Last Name

Male / Female *

Male Female

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Phone Number *

Area Code Phone Number

Email *

example@example.com

Please make a brief statement describing why your family is in need of financial assistance. *

To be Completed by Parent / Guardian

Which award are you applying for?

Are you able to serve as a parent volunteer? *

How many kids are you enrolling in the academy program? *

Do you plan to enroll in the full family academy program? *

Please indicate how much you can pay per month. (If Applicable.) *

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.

Parent / Guardian Name *

First Name Last Name

Parent / Guardian Signature *

Clear

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 your child(ren) is 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 divvy up the Financial Assistance funds received until they are diminished. We will notify applicants of the award amount within 2/4 weeks. Need is the most important priority for the Financial Assistance Program.

EPIC Homeschool Network Scholarship Application