SCHOLARSHIP APPLICATION FORM

IRVINGTON EXTENDED DAY INC, ALAMEDA/BEAUMONT PREK PROGRAM

 Please read thoroughly and return the Scholarship Forms only!

 We have many requests and we depend upon your accurate and complete description of your financial situation to help us make the best decision we can concerning the limited amount of money available for assistance.  Please let us know if you are eligible for any state or federal assistance for childcare. This includes the free/reduced lunch program available through the school. IED/ABPP will be happy to accept state and federal funds. Those who receive reduced lunch may receive up to a 25% discount off the regular tuition. Those who receive free lunch may receive up to a 50% reduction off the regular tuition.

 Please be aware that scholarship recipients may be subject to fee increases just as regular paying families are.  It is up to the scholarship recipient to submit a new application by the deadline to be considered for additional scholarship assistance.

 If there are changes in your income, you must notify IED/ABPP. Please be aware that you may be required upon request to provide a new application updating your records to qualify for financial assistance.  IED/ABPP may terminate your scholarship at any time if it learns that the financial information provided contains significant inaccuracies or is untruthful.  All scholarship applications are subject to inspection on a quarterly basis.  You will be asked to re-apply in the middle of the school year.  You will be given notice before the application is put in your folder, and you will be given a clear deadline.  If the application is not re-submitted by the deadline, you may lose your scholarship.

 Finally, if IED/ABPP loses its funding base for the scholarships it is providing, IED/ABPP retains the right to terminate the scholarships so long as it provides two weeks notice to the scholarship recipients.  If IED/ABPP loses part of its’ funding and is therefore able to continue funding some of the scholarships but not all it may at its discretion terminate scholarship awards.

 Please tell us, as best you can, why you are requesting scholarship assistance.  We are not concerned with spelling, grammar, or writing style.  We are interested in hearing about any conditions or situations which you feel will help the scholarship committee in their decision making process.  In setting forth your income and financial situation please include any real property you own and ownership of any personal property valued at $500 or more.

 Feel free to attach an additional sheet of paper to the application. Incomplete scholarship applications will not be reviewed.  You must include proof of income, expenses, and the award letter from free/reduced lunch program!***

 FINANCIAL INFORMATION

(Please include totals for ALL household members)

 NAME OF APPLICANT/S

Income:

(ATTACH COPIES OF INCOME STATEMENTS)

 Monthly wage, Salary, etc.:                                                 ________________

Child Support/Alimony (specific amount)                               ________________

Additional Income (Unemployment, General Asst., etc.)         ________________

TOTAL INCOME OF HOUSEHOLD:                                       ________________

Expenses:

(ATTACH PROOF OF EXPENSES)

Rent, Mortgage, Lodging, etc.:                                                ________________

Utilities (include Heat, Electricity, Water/Garbage):              ________________

Telephone (basic service):              ________________

Transportation (Auto, Bus-please estimate)              ________________

Food and Incidentals (average monthly payments)              ________________

Medical (Insurance-if any regular payments)              ________________

Any other expenses we should know about?              ________________

TOTAL OF ALL MONTHLY EXPENSES              ________________

TURN PAGE OVER

TOTAL ASSETTS:

IRA, 401K, Retirement accounts:              ________________

Stock Accounts, Bonds, and Investment Accounts:              ________________

Market Rate Accounts or Certificates of Deposit accts:              

Saving and Checking Accounts:              

Real Property:          

Personal Property:

Car(s) include Make/Model:                        

Recreational Equipment valued at $500 or more:          

 Other Personal Property valued at $500 or more:          

 STATE AND FEDERAL BENEFITS:

 SOCIAL SECURITY:              _______________             

DISIBILITY ASSISTANCE:              _______________

VETRAN’S BENEFITS:              _______________

STATE WELFARE ASSISTANCE:          _______________

AFDCS:              _______________

OTHER STATE/FEDERAL BENEFITS:    _______________

 **ALL INFORMATION WILL BE KEPT CONFIDENCIAL.