| Parent/Guardian Name |
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| Reasons you are requesting a scholarship at this time: |
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| What scholarship amount are you requesting per week? |
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| For how long would you like to receive this assistance? |
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| Is there anything else you feel we should be aware of regarding your request? |
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| Have you tried to get assistance through W-2? |
yes no |
| Please supply us with a copy of your W-2 denial letter (if applicable), two current payroll check stubs per parent, and your latest Federal and State income tax returns. This information, when complete, will be reviewed by the Scholarship Committee and a decision to approve or deny will be provided within 10 working days. |
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