In order to qualify as an applicant for this scholarship we need to review specific financial information to ensure the scholarship is granted to someone that needs financial assistance to cover tuition costs. Please complete the section below to the best of your abilities and attach supporting documentation where applicable:

1. Applicant Information

Name *

First

Middle

Last

Email *

Phone *

Date of Birth *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

2. Household Information

a) List all individuals that live with you and their relationship to you

Name *

Relationship to Applicant *

Is the individual a minor? *

Yes
No

Name

Relation to Applicant

Is the individual a minor?

Yes
No

Name

Relationship to Applicant

Is the individual a minor?

Yes
No

Name

Relationship to Applicant

Is this individual a minor?

Yes
No

Name

Relationship to Applicant

Is this individual a minor?

Yes
No

If more people live in your household, please attach a list with additional individuals

b) Do you receive support from individuals not living with you?

Do you receive support from individuals not living with you? *

Yes
No

c) If you answered Yes in the previous question, please provide the following information for the individuals providing you with support:

Name

Relationship to Applicant

$ Amount of support (Annual)

Name

Relationship to Applicant

$ Amount of support (Annual)

3. Limited Savings Capacity Test

Complete the following on a household level (i.e. sum of all individuals listed in 1.a):

Household Income / Month

Rent / Mortgage Payment *

Average Utility Costs / Month *

Child Care Costs / Month

Other Recurring Costs / Month (Average). List below where applicable

Other Costs / Month (Average)-1

Other Costs / Month (Average)-2

Other Costs / Month (Average)-3

Other Costs / Month (Average)-4

Other Costs / Month (Average)-5

Other Costs / Month (Average)-6

Include financial obligations (leases, loans, etc.) and any other relevant monthly costs that impact your ability to generate savings