Common Ground Financial Aid Application
Privacy Statement: Information provided on this form is for use by Common Ground Staff to determine eligibility for financial aid. This information is kept private and will not be used for any purpose other than determining eligibility for financial aid.
Family Information
Parent/Guardian Name *
Email address *
we will use this address to reply to your financial aid request - please be sure it is a valid email address!
Phone number *
we will use this phone number if we cannot reach you by email
Name of child you are requesting financial aid for *
You may include more than one child here
What school does your child attend? *
Town you live in *
for data purposes only, residents of any town are eligible for financial aid
Household Members and Annual Income
This information is used to determine the total amount of financial aid you are eligible for
Total number of people in your household (including all children and adults) *
Total ANNUAL household income, before taxes or other deductions? Include all salaries, wages, and business income, as reported on your most recent tax return. *
Total ANNUAL additional income from child support or alimony *
Total ANNUAL additional income from pensions, retirement, Social Security, or other *
Programs you are requesting financial aid for
Check all that apply, this does not obligate you to register for the program
What program(s) are you interested in registering your child for? *
Electronic Signature
I certify that all of the above information is true and correct and that all income is reported.
Name of person completing this form *
this is your electronic signature
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