Tuition Assistance Application Summer 2023

Tuition Assistance Application Summer 2023
March 2023

Dear MB Families,

Mind-Builders is now accepting tuition assistance applications for all of our group classes only.

Attached you will find the Tuition Assistance Application Summer 2023.

We are committed to providing quality arts education to our community and making sure that everyone has access to our classes and that financial challenges will not become an obstacle to having students join and take classes. In order for MB to make a fair determination, we ask that you confidentially disclose your current financial status.

We would also like you to encourage your family members, friends, and employers to make a donation, if possible, to the Mind-Builders Tuition Assistance Fund by visiting www.Mind-Builders.org. All donations are tax-deductible and can help make classes available to more students whose families can use assistance at this time.

Feel free to call Mind Builders and speak with Liza Rodriguez at Office (718) 652-6256, if you have any questions or if you need additional assistance with this application.

Kind Regards,

Natasha Richards
Assistant Executive Director of Finance and Operations

Tuition Assistance Application Summer 2023
FAMILY INFORMATION
New StudentReturning Student
Name(s) of Student(s)*
Parent/Guardian/Student *
Relationship to Student(s)*
Street Address*
APT#*
City*
State*
Zip Code*
Cell phone number*
Home/Work number
E-Mail Address *
example@example.com
STUDENT INFORMATION
1st Student Name/Age/Class(es) Applying for Tuition Assistance
2nd Student Name/Age/Class(es) Applying for Tuition Assistance
3rd Student Name/Age/Class(es) Applying for Tuition Assistance
Any Additional Student(s) Name/Age/Class(es) Applying for Tuition Assistance
FAMILY INFORMATION
Number of adults living in household*
Number of youth living in household*
Please explain any other factors that affect your ability to pay*
How much monthly tuition can you afford?*
CURRENT HOUSEHOLD INCOME SOURCES

(Please complete your household sources of income)
Current Monthly Employment Wages: Parent/Guardian/Student
Current Monthly Employment Wages: 2nd Parent/Guardian/Student
Current Monthly Unemployment Benefits: Parent/Guardian/Student
Current Monthly Unemployment Benefits: 2nd Parent/Guardian/Student
Current Public Assistance Benefits: Parent/Guardian/Student
Current Public Assistance Benefits: 2nd Parent/Guardian/Student
Current SSI/Disability Benefits: Parent/Guardian/Student
Current SSI/Disability Benefits: 2nd Parent/Guardian/Student
Current Child Support Benefits: Parent/Guardian/Student
Current Child Support Benefits: 2nd Parent/Guardian/Student
Please Upload Proof of All Current Household Income Sources (black out Social Security#)*

Browse Files
If you having trouble please contact arodriguez@mind-builders.org Cancelof

Tuition Assistance Application Summer 2023
If Tuition Assistance is granted to the above student(s), I understand and agree that: (Please initial each box below)
I will be responsible for all tuition fees not covered by my award: (Please initial below)*
I will maintain my payment schedule: (Please initial below)*
I will be responsible for making certain that the student (s) attend regularly (more than 3 absences can lead to review of tuition assistance and possible termination): (Please initial below)*
Waiting list procedure: When all available tuition assistance has been awarded, remaining T.A. applicants are placed on a waiting list. The School will continue to accept applications with the expectation that additional funds may become available throughout the program semester.

I hereby affirm that the information contained in this application is true and correct. If my financial circumstances change, I will notify Mind-Builders Creative Arts Center. In the event that it is determined that any of the statements in this application are not true or not correct, any amount granted as tuition assistance will immediately be deemed a debt and payable by me to Mind-Builders Creative Arts Center.
Parent/Guardian/Student Signature (Please use your cursor to sign here)*

Clear
Date*

MonthDayYear
Date
Co-Applicant Signature

Clear
Date

MonthDayYear
Date
Monthly Total of All Sources of Income
Should be Empty:

Tuition Assistance Application Summer 2023

Tuition Assistance Application Summer 2023

FAMILY INFORMATION

STUDENT INFORMATION

FAMILY INFORMATION

CURRENT HOUSEHOLD INCOME SOURCES

Tuition Assistance Application Summer 2023