SSSC Special Scholarship Application

Student Name*

First Name Last Name

Address*

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Date of Birth*

Date

Phone Number*

Please enter a valid phone number.

Guardian 1 Full Name*

First Name Last Name

Guardian 1 Address (if different from student)

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Guardian 1 Email*

example@example.com

Guardian 1 Phone Number (if different from student)

Please enter a valid phone number.

Guardian 1 Occupation*

Guardian 1 Employer*

Guardian 1 Annual Income Before Taxes *

Please upload a copy of Guardian 1 most recent W-2 or 1099.*

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Guardian 2 Name

First Name Last Name

Guardian 2 Email

example@example.com

Guardian 2 Address (if different from student)

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Guardian 2 Phone (if different from student)

Please enter a valid phone number.

Guardian 2 Occupation

Guardian 2 Employer

Guardian 2 Annual Income Before Taxes

Please upload a copy of Guardian 2 most recent W-2 or 1099.

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Please list the annual amount and sources of any additional family income you may have. This could include annual child support, support for educational expenses, trust funds, annual social security for children, rental properties, etc. If none, please type NA.*

Number of people living in your household:*

Number of dependents not living in your household (i.e. college students):*

Please list the monthly amount of any car payments you may have. If none, please type NA.*

Please list the monthly amount of any medical bills you may have. If none, please type NA.*

Please list the monthly amount of any credit card debt you may have. If none, please type NA.*

Please list the monthly amount of any rent or mortgage payments you may have. If none, please type NA.*

Please list the monthly amount and describe any other debts you may have. If none, please type NA.*

Student Essay: In 100-200 words, please have your student describe why music matters to them and why they want to be part of OKYO.*

Family Needs Statement: Please describe why your family is seeking a Special Scholarship along with any other relevant information you wish for the committee to consider when determining awards.*

By typing your name below, you acknowledge that you have represented accurate information in this application and provided fair disclosure of your present financial situation. You further acknowledge that this application will be reviewed by a committee set forth by the OKYO Board of Directors and that your information will remain confidential.*

OKYO Special Scholarship Application