DMF Scholarship Application 2023

Dynamite Montessori Foundation

Carefree, AZ 85377

DMAFoundation.com

2023-2024 Scholarship Application Form

To complete the requirements for applying for Dynamite Montessori Foundation (DMF) Scholarship for 2023-2024, the parent/guardian must provide the following information: A completed and Signed Application

Student's Last Name*

Student's First Name*

Name of School Student is currently attending *

Name*

First Name(s)Parent/Guardian's Last Name

Address*

Home Address

Street Address Line 2

City/State

Main Phone*

Email*

example@example.com

Zip*

Please note, DMF cannot award, restrict or reserve scholarships on the basis of a donor's recommendation. A taxpayer may not claim a tax credit if the taxpayer agrees to swap donations with another tax payer to benefit either taxpayer's own dependent.

My Child or dependent is deserving of a grant or scholarship based upon the following needs: Financial, Job, Family, Health or Other Circumstances. Describe what tuition cost you are incurring for other students in K 12 & College, etc.*

Describe the merits of the student. Such merits might include the following: Character, Perseverance, Scholastic ability, Citizenship, Leadership, and Community involvement. (You may attach additional pages if necessary. The child's age will be considered.*

I certify that all of the statements contained in this scholarship application form are true and correct, to the best of my knowledge.

Parent/Guardian Printed Signature*

Date*

Date

Parent/Guardian Printed Name*

This form must be completed by all applicants.

1. Basic Participation (Must participate in all the items listed below to be eligible)

I am current on my financial responsibilities to my school.
My child has at least a 90% attendance record.
My child has been in Montessori Education for _____. years. Date enrolled:
I have observed in my child's class. How many times?
I have attended Parent/Teacher Conferences.
I have attended the school sponsored parent night.
I have attended Back to School/Orientation/Meet the Teacher Event.

1.*

2. I have volunteered in my child's classroom (List all that apply).

Reading with children
Crafts
Field trips/Going Out
Birthday Celebrations
Luncheons
Holiday Celebrations (list celebrations)
Shared cultural information or Lesson on Professions to class
Attended school-wide Events : (list events)
Other (list any other volunteer hours or events you have participated in):

2.*

3. Contribution Programs (List all that apply. Scholarship Type D must have made a personal tax donation; all applicants must participate in at least 2 during the year)

I have made my personal tax credit donation to MSO this tax year. (required for applicants of Type D)
My family/friends have made MSO tax credit donations this tax year. How many (attach a list of possible contributors to be sure you get full credit for your fundraising efforts)
I have raised tax credit funds for the past years. I have participated in the following school sponsored fundraisers: (list below)

3.*

Any misstatements may be grounds for disqualification of a DMF scholarship. A student may NOT accept Empowerment Scholarship (ESA) funds and DMF Scholarship funds at the same time.***

Dynamite Montessori Foundation Scholarship Commitment: For Families who meet Dynamite Montessori Foundation's (DMF) conditions of eligibility (listed below), DMF will pay either 100%, 75%, or 50% of the amount of the student's private school tuition based on financial need, school participation, Montessori experience, and recommendation of the school administrator.

See the Income Information Form for more information.

Are you a new application or renewal applicant (received DMF scholarship in past)? *

What was your total gross yearly income in 2022?*

How many members are in your household? *

Proof of Income must be attached. Provide copies of your Arizona State Tax Return Form 140 (first two pages only)

Special Circumstance - Has your financial situation recently changed? If so, list all that apply:

Loss of JobUnexpected change in income
Bankruptcy
Had a baby
Recently divorced/separated
Change in work
Foreclosure
Change in family living arrangements
Other (Please Explain)

List all that apply: Unexpected change in income*

I certify that the all the information provided above is correct. I understand that all information obtained for scholarship applications will remain personal and confidential.

Parent Printed Name*

Parent Signature*

Date*

Date

Note: Dynamite Montessori Foundation (DMF) will not award, restrict, or reserve scholarships solely on the basis of donor recommendation. A taxpayer may not claim a tax credit if the taxpayer agrees to swap donations with another taxpayer to benefit either taxpayer's own dependent.