Tuition Assistance Application

Financial Assistance Application

Please fill out a form for EACH student that you wish to receive assistance. If you need help completing this form, please contact our staff at 801.474.3796 or in-person at our office at 2900 S 300 W, South Salt Lake, UT 84115.
Parent/Guardian Name *

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Address *

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is this the best emergency contact for this student?*

YesNo
If no, please put the name, phone number, and email address for the best emergency contact for this student.
Does your family qualify for the Federal Free School Lunch Program?*
Yearly Household Income:*
Household Size (Adults AND Children)*
What percentage of tuition reduction are you requesting?*

100%75%50%25%
Could you contribute to tuition in other ways?*

VolunteerSuppliesNot able toOther
Special Financial Considerations (please describe)
Student's Name*

First NameLast Name
What program does this student want to be enrolled in?*
What grade will student be going into this fall?*
Student's Birthdate*
What school are they attending?
Student's Race*

American Indian or Alaskan NativeAsianBlack or African AmericanNative Hawaiian or Other Pacific IslanderWhite/Caucasian
Student's Ethnicity*

Hispanic or LatinoNot Hispanic or Latino
Does this student have any medical issues/allergies/special needs that VAI needs to know about?*
Photo Release: VAI may use photos of this student in marketing/grant proposal.*

Yes, VAI may use photos of this student in marketing/grant proposals.No, VAI may NOT use photos of this student in marketing/grant proposals.
Proof of Income is required. *

Mail documents to:

Visual Art Institute PO BOX 522285, Salt Lake City UT 84152-2285

Document Checklist (submit at least two)

Free or Reduced School-Lunch

Copy of the 1st page of your most recent Tax Return

Current W2 Form

DWS Financial Benefit Statement

Employer Verification Statement

Housing Authority Annual Income Form

Other
I understand that all information I provide is private and confidential.
BY ACKNOWLEDGING AND SIGNING BELOW, I AM ATTESTING THAT ALL OF THE ABOVE INFORMATION IS ACCURATE AND TRUE, AND THAT DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE. **

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Financial Assistance Application