COMMUNITY CHRISTIAN SCHOOL Scholarship Application
Date
-
Month
-
Day
Year
Date
We are desirous of having Community Christian School work with us in the total Christian education of our child(ren) and request a scholarship to enroll the following child(ren) in Community Christian School. Name of child(ren) to attend CCS:
Child (1) Full Name
Child (1) Grade Level
Child (2) Full Name
Child (2) Grade Level
Child (3) Full Name
Child (3) Grade Level
Child (4) Full Name
Child (4) Grade Level
PARENT INFORMATION:
Parent Name(s)
Address
City
Zip
Home Phone:
Format: (000) 000-0000.
Husband's Occupation
Wife's Occupation
TUITION:
Annual Tuition Fees for your family:
NOTE: THIS DOES NOT INCLUDE REGISTRATION FEES
$
Amount you can Pay:
Scholarship amount desired:
Have you ever received a scholarship from CCS?
If Yes, When? & How Much?
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FINANCIAL INFORMATION
Adjusted Gross Income as reported on last Income Tax Return (ATTACH A COPY OF FORM 1040) This application will not be processed if tax return is not attached.
If significant change, projected income for next year
Please Explain -
How much do you owe on the following:
House:
Monthly Payment:
Vehicles:
Monthly Payment:
Credit Cards:
Monthly Payment:
List any other debts you have:
Do you have any past due bills:
Yes
No
List any additional sources of income not reported on FORM 1040
Social Security / Workman's Compensation
Frequency
Weekly
Monthly
Yearly
Public Aid (AFDC, Welfare, etc.)
Frequency
Weekly
Monthly
Yearly
Child Support
Frequency
Weekly
Monthly
Yearly
Other source of income
Frequency
Weekly
Monthly
Yearly
If separated or divorced what percent of tuition will the other parent pay?
Special financial circumstances to be considered:
All information provided on this form is true and complete to the best of my knowledge.
Father's Signature
Mother's Signature
Tax Return
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