FIM Lesson Scholarship Form
Any information that you provide, including this application itself, is strictly confidential and voluntary. Although CKYO does not want anyone to be denied participation because of inability to pay, we do have limits on the number of scholarships we can provide. If you had a scholarship in previous years, it does not guarantee a scholarship this year. Scholarships are awarded on a first come, first serve need basis.
Student Name *
Your answer
Student School *
Lesson Request
Before scholarship,
20 minute lessons are $12.50 each or $300 throughout the school year.
40 minute lessons are $25 each or $600 throughout the school year.
Would you like to request a scholarship for a 20 or 40 minute lesson? *
Out of the total lesson cost per school year, what amount could you reasonably pay if making payments? *
What amount would you be able to pay for lessons if an option was not selected above?
Your answer
Please give a written statement about why your child is requesting scholarship: *
Your answer
Financial Data
Number of Adults in the Household *
Number of Children in the Household *
Does your child qualify for the free or reduced lunch program? *
Your annual gross family income is approximately: *
Do you: *
Please list $ amount of other sources of income (child support, AFDC, social security, etc) *
Your answer
Parent Signature
I hereby request scholarship assistance for private lessons. I certify that my student would not be able to participate in FIM lessons without scholarship support.
*
Your answer
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