Partial Scholarship Application

Parent / Guardian Full Name

First NameLast Name
Parent / Guardian's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent / Guardian's Primary Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent / Guardian's Email
example@example.com
I affirm the information that I have provided on this application (and any supportive materials) is complete, accurate, and true to the best of my knowledge. I understand that furnishing false information will result in not being considered for, or revocation of All Aboard Scholarship financial assistance. I understand that, if selected for a scholarship, All Aboard may use my photograph and/or testimonial for promotion and public relations purposes.
Enter the Applicant's name here to confirm the above statement:

First NameLast Name
Today's Date

MonthDayYear
Date

Statement of Financial Need
In one (1) or two (2) paragraphs, please explain why you are requesting scholarship funds from All Aboard. Include any changes in your life that have impacted your ability to pay, such as changes in your family income or other circumstances.*
How would you benefit from receiving All Aboard scholarship funds?*
Do you attend other activities/events outside of All Aboard? (Please list) If so, how often?*

Proof of Income

CONFIDENTIAL
Income verification is required to determine All Aboard scholarship eligibility. Select one of the following forms of proof and upload below*

W-2 withholding statementThree most recent pay stubsMost recent income tax returnWritten, signed statement(s) from employer or othersApproval/denial of eligibility for MedicaidSSI benefits statement
Upload the document selected above*

Cancelof

Applicant Monthly Income

Applicant Monthly Expenses

Assets*

Rows	Amount
Current Checking Account Balance
Current Savings Account Balance

Parent/Guardian Monthly Income

Rows	Monthly Income Amount
Total Household Salary
Stocks/Bonds/401K/Health Savings/Trusts
Other Income Sources
Comments

Parent/Guardian Monthly Expenses

Parent/Guardian Assets

Rows	Amount
Current Checking Account Balance
Current Savings Account Balance

I affirm the above information is true and correct to the best of my knowledge. I understand if the information I give is determined to be false, the result will be denial of All Aboard scholarship funds, and I will be responsible for and expected to pay for all services provided.*

Authorization for Release of Confidential Information
I First Name Last Name authorize my DDA Caseworker First Name Last Name to release the following information: 1) Confidential conversation as to supports and services provided to the applicant, and 2) verification of income, to All Aboard for the following purposes: To evaluate eligibility for All Aboard scholarship.
I, the above listed individual, hereby authorize the release of information to the individual(s) named above for the reasons specified . I acknowledge by my signature that I understand that, although I am not required to release my information, I am giving my consent to do so. Additionally, I understand that I may revoke this authorization in writing at any time, except for that information which has already been released with consent and prior to my revocation.
Participant Signature*
Parent or Guardian Signature
Today's Date*

MonthDayYear
Date
Should be Empty:

Statement of Financial Need