CKYO Tuition Assistance Application

CKYO 2023 Financial Assistance Application

SPRING SEMESTER DUE January 31, 2023
Student Name*

First NameLast Name
Parent/Guardian Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Email*
example@example.com
Phone Number
Tuition Assistance Requested Level*

Full Tuition amountHalf Tuition Amount
To be Completed by Parent / Guardian
Please make a brief statement describing why your family is in need of tuition assistance. *
To be Completed by Parent / Guardian

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

	Under $20,000	$20,000-$30,000	$30,001-$40,000	$40,001 and Up
Income

The items listed below may be transferred from your 1040 or reported as you understand them to be true.
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 completing and submitting this application:
- I hereby request scholarship assistance for tuition.
- I certify that my child would not be able to participate in CKYO without scholarship support.
- I understand that CKYO may require volunteer hours throughout the year and the completion of an exit survey.
Please Note: Financial assistance is not guaranteed. It will be determined based on the information provided in this application. Assistance will be given based on the availability of funds and level of need.

Our Board of Director's Finance Committee will review applications. This application is confidential. The information on the form will not be disseminated. We will notify applicants of the award amount by Friday, January 20, 2023.

Need is the priority for the Financial Assistance Program of CKYO and we hope to be able to provide tuition assistance for any student who demonstrates that need.
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CKYO 2023 Financial Assistance Application