ESYO Financial Aid Scholarship Application (Confidential)
Scholarships for program fees, instrument rentals, and private lessons are available to any ESYO family according to federal guidelines for income. Due to the availability of funding, the award of one scholarship does not guarantee the award of another. Scholarships are available to students enrolled in an ESYO class or ensemble.
Please check all that apply :
Student Name *
Your answer
Ensemble/Orchestra *
Please list the monthly amount for each household member who earns income. Be sure to total all at the end, and include total number of people living in household.
Family Member 1 Name:
Your answer
Monthly Earnings (before deductions) for family member 1
Your answer
Other Income for family member 1 (welfare, child support, social security, alimony, retirement, unemployment, food stamps, etc.)
Your answer
TOTAL Monthly Income for Family Member 1
Your answer
_________________________________________________
Family Member 2 Name:
Your answer
Monthly Earnings (before deductions) for family member 2
Your answer
Other Income for family member 2 (welfare, child support, social security, alimony, retirement, unemployment, food stamps, etc.)
Your answer
TOTAL Monthly Income for Family Member 2
Your answer
_________________________________________________
Family Member 3 Name:
Your answer
Monthly Earnings (before deductions) for family member 3
Your answer
Other Income for family member 3 (welfare, child support, social security, alimony, retirement, unemployment, food stamps, etc.)
Your answer
TOTAL Monthly Income for Family Member 3
Your answer
_________________________________________________
TOTAL HOUSEHOLD MONTHLY INCOME (add all family member income from above) *
Your answer
TOTAL number living in household (including children and anyone dependent on total household monthly income) *
Your answer
Declaration 1: I agree to pay any remaining balance in full or set up a payment plan as listed in section 7 of my registration.
Declaration 2: I understand that ESYO reserves the right to request additional supporting document(s) to verify the above-stated income.
Declaration 3: I understand that the participant's previous accounts with ESYO must be current in order to be awarded a scholarship.
Declaration 4: I understand that the information on this form must be accurate and is given for the sole purpose of determining qualifications for awarding an ESYO Scholarship.
Parent or Legal Guardian Name (by entering my name I agree to the above declarations) *
Your answer
Parent or Guardian Email: *
Your answer
Preferred Phone Number: *
Your answer
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