Vero Beach Theatre Guild's TLC Scholarship Form

Scholarship Application

Beetlejuice Jr.
Student Information*
Parent/Guardian Information (Emergency Contact 1):
Name*

First NameLast Name
Relation to Student*
Cell-Phone*
Please enter a valid phone number.
Work Phone*
Please enter a valid phone number.
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Information (Emergency Contact 2):
Name

First NameLast Name
Relation to Student
Cell-Phone
Please enter a valid phone number.
Work Phone
Please enter a valid phone number.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Scholarship Application

Please list the people in your household:
- Yourself
- Your spouse/partner
- your children, even if they do not live with you, provided that they are still your dependents; and
- Other members of your household living with you and which you provide for their cost of living expenses
Family Household List*
Annual Household Income

Please only list the people in your household that have income.

Please note that the amounts should be the annual total of each section.

Click the "+" button to add an additional household member's income.
Annual Household Income*
Certification

I certify (promise) that all information on this application is true and that all income is reported. I understand that the school will get Federal funds based on the information I give. I understand that school officials may verify (check) the information. I understand that if I purposely give false information, my children may lose meal benefits, and I may be prosecuted. I understand my child's eligibility status may be shared as allowed by law.
Last 4 Digits of Social Security number:
Type your full name below to serve as your signature.
Date*

MonthDayYear
Date
Children's Ethnic and Racial Identity (Optional):
Type a question

Hispanic/LatinoAsianBlack or African AmericanAmerican Indian or Alaska NativeWhiteLatino Hawaiian or other Pacific IslanderOther
Should be Empty:

Scholarship Application