Scholarship Application Form

Head of Household Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Email *

Phone *

Number of school-aged children living in the house *

Of those living in the house, how many will be enrolling into Utica Christian School? *

Monthly Income from all sources (wages, self employment, social security, unemployment, child support, etc.) *

Monthly Rent/Mortgage payment amount *

Approximate Monthly Utilities amount *

Monthly Vehicle Payment amount *

Please list any other income or expenses that we should take into consideration

Please indicate that you have read and agree with each of the below statements by checking each of the boxes.

Agreement #1 *

Please indicate that you have read and agree with each of the below statements by checking each of the boxes.

Agreement #2 *

The student’s records in Utica Christian School (or transferring school) will be used to help determine initial and recurring eligibility.

Agreement #3 *

All applicants will be given careful consideration. However, because funds are limited, acceptance will be determined by need and availability of funds.

Agreement #4 *

Potential approved applicants will be required to meet with our school Administrator . Please note: You must be willing to share your W2 and other personal financial records with the Administrator before you will be approved for a scholarship.

Agreement #5 *

All information given on this application is provided voluntarily by the applicant and will be held in strictest confidentiality.

Agreement #6 *

Applicant agrees to notify Utica Christian School of any change in income while receiving assistance.

Agreement #7 *

By signing below, you are indicating that you fully understand and agree with everything on this application.

Signature *

Clear Signature

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Scholarship Application Form

Please indicate that you have read and agree with each of the below statements by checking each of the boxes.

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About Utica Christian School

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Scholarship Application Form

Please indicate that you have read and agree with each of the below statements by checking each of the boxes.

Need Assistance?

About Utica Christian School

Privacy

Terms

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