First Name *

Last Name *

Street Address *

City *

State *

Zip Code *

Email Address

Home Phone Number

Work Phone Number

Cell Phone Number

What is your total monthly income? (before taxes) Be sure to include any public assistance, child support, alimony, or cash income. *

Number of people living in the home? *

Is your household currently receiving any form of financial assistance? *

If you are receiving financial assistance, what type? What is the amount?

Please provide any additional information you may have supporting your need for financial assistance.

What is the program or class title for which you would like to register? *

What is the fee for the program or class in which you are interested? *

Funds for scholarships are limited. As a result, we must have a commitment on the part of participants to attend the programs or classes for which they have registered. Scholarship funds will be forfeited if you transfer, cancel or are absent from the program or class. *

By typing your name below, you are certifying that all information provided in this form is true and accurate. Income verification may be required. *

Thank you for your interest in Wayzata Community Education. You will be contacted within 7-10 business days regarding the status of your application.