PS10 PTA Extended Day
Scholarship Request Form
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Email *
                                         Scholarship Application 2023 -2024
Parent / Guardian 1 Name
 *
Parent / Guardian 1 Address
 *
Parent/ Guardian 1 Phone
 *
Parent  Guardian 2 Name
 *
Parent / Guardian 2 Address
 *
Parent / Guardian 2 Cell Phone
 *
Name of all Students Requiring Scholarship
*
Grade of All Students Requiring Scholarship
 *
Who else resides with students (siblings, grandparents...) *
Please describe any special financial circumstances affecting the family’s budget (Public assistance, Child support). *
Total Combined Household Incomes in 2022 *
Please be aware that the final step in the scholarship process is to verify annual income.   Scholarship requests will not be considered without income documentation, it will be used solely to determine eligibility.  Please provide a copy of your 2022 1040 Income Tax Form.  This information will be kept secure and will be shredded / deleted after scholarships have been awarded. If you did not file US income tax forms last year, please speak with the Director to determine what documents you need to submit.
Anything else you would like us to know? *
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