77: CKYO Tuition Assistance Application

Student Name*

First NameLast Name

CKYO Orchestra*

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

Assistance Requested Level*

Spring Semester Full Tuition AmountSpring Semester Half Tuition AmountOther

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-$35,000	$35,001-$50,000	$50,001 - $65,000	$65,001 and up
Income

The items listed below may be transferred from your 1040 or reported as you understand them to be true. CKYO does NOT require a copy of your 1040 or pay stub, etc.

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 assistance for tuition.
I certify that my child would not be able to participate in CKYO without this 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 and is determined based on the information provided in this application, however, CKYO makes every effort to grant the requests we receive.

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 September 1, 2024.

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.

CKYO 2024-2025 Tuition Assistance Application

To be Completed by Parent / Guardian