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 *
Your answer
Email address *
we will use this address to reply to your financial aid request - please be sure it is a valid email address!
Your answer
Phone number *
we will use this phone number if we cannot reach you by email
Your answer
Name of child you are requesting financial aid for *
Please submit a separate form for each child that you are requesting financial aid for
Your answer
What school does your child attend? *
Your answer
Town you live in *
for data purposes only, residents of any town are eligible for financial aid
Your answer
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) *
Your answer
Total annual household income (before deductions) *
Your answer
Does your family receive food stamps or WIC? *
Total additional income from child support or alimony *
Your answer
Total additional income from pensions, retirement, Social Security, or other *
Your answer
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
Your answer
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