CMS Financial Aid Scholarship Application Form

CMS Financial Aid Application
Student Name*

First NameLast Name
Email of Parent / Guardian (or Adult Student) *
example@example.com
Phone Number*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student School Grade, or list Adult *
CMS Semester (list spring or fall and year) *
Enrollment for CMS this semester (private lesson instrument & lesson length, orchestra, etc)*
How long has the student participated in CMS? Include any time in the Pre-College program if applicable.*
If Parent / Guardian, do you have other children participating in CMS this year?*

YesNoI am an Adult Student
Financial Information

To be completed by Adult Student or Parent / Guardian.
Please explain why the student is in need of financial assistance. *
To be Completed by Adult Student or Parent / Guardian
What is your occupation / job title and place of employment? *
What is spouse's occupation / job title and place of employment? *

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

	Under $30,000	$30,000-$50,000	$51,000-$75,000	$76,000 -$100,000	Over $100,000
Income

The items listed below are to be transferred from your 1040: (Includes spouse's information if applicable).
Number of Dependents*
Line 6C on 1040, Line 5on 1040 EZ or Line 6C on 1040A.
Total Annual Income (include spouse's info if applicable)*
Line 22 on 1040 or Line 15 on 1040 A.
Adjusted Gross Annual Income
Line 37 on 1040, Line 4 on 1040 EZ or Line 21 on 1040 A.
List Special Circumstances (If Any)
By signing with my digital signature below, I agree that the information submitted on this form is accurate and complete.

Please list any income from non-tax filers in the household. Please submit bank statements from the previous 6 consecutive months or other supporting documentation (either below, or email to musicschool@etsu.edu).

	Name	Employer	Income past 6 mos
Non-tax filer 1
Non-tax filer 2
Non-tax filer 3

Parent / Guardian or Adult Student Name*

First NameLast Name
Parent / Guardian or Adult Student Signature*

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Supporting Financial Documentation

Please submit a copy of your most recent tax records and/or other supporting documentation. Social Security numbers and other sensitive information can be marked out for security.

Non-tax Filers: Please submit copies of bank statements for the last 6 consecutive months or other supporting documentation.

Records and supporting documentation can be sent using the file upload tabs below or emailed to musicschool@etsu.edu.
Tax Records, Bank Statements, or Supporting Documentation:

Cancelof
Tax Records, Bank Statements, or Supporting Documentation:

Cancelof
References (Optional)

If you have someone other than a family member who would like to attest to the student's character, musical ability, financial need, or otherwise recommend a financial aid scholarship on the student's behalf (Ex. Instructor, School Administrator, Band or Choir Director, Scout Leader, etc.), please include a brief statement made by the reference, a reference signature, and list the relationship to the student. References can be uploaded below, or emailed to musicschool@etsu.edu.

Please have the reference make a brief statement describing why this student deserves a financial aid scholarship to CMS.

References can be sent using the file upload tab(s) below or can be emailed to musicschool@etsu.edu.
Recommendation Letter 1 (Optional):

Cancelof
Recommendation Letter 2 (Optional):

Cancelof
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.

This application is confidential. The information on the form will not be disseminated.

We will notify applicants of the award amount sometime near the beginning of the semester.

Need is the most important priority for the Financial Assistance Program.
Should be Empty:

CMS Financial Aid Application

Financial Information