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HSYO Need Based Assistance Application
This form must be completed by a parent or guardian for student under 18.  All information is confidential and will be seen only by senior staff and the scholarship committee.
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Student Name *
Parent/Guardian Name *
Mailing Address *
Parent Email *
Parent Phone number *
Instrument(s) *
Years in HSYO *
What activity will the requested Educational  Scholarship help to fund? *
Describe in detail the educational activity covered by the Scholarship.  Include dates, location of camp, instructor, tuition, source of instrument or repair, etc. *
What is your Adjusted Gross Income from last year's Federal Tax Return? *
What is the Taxable Income included above? *
How many people are dependent on the above income? *
Please describe any pertinent financial or situational information that you would like the scholarship committee to be aware of in considering this application for scholarship aid. *
By typing your name below and submitting this form, you agree that all of the above information is accurate and correct. *
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