Note: Applicant’s income will be verified with tax return, paycheck stub, or other appropriate document. |
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Note: to Parent/Guardian: Please circle the size of your household and your total household income below, and |
sign to verify your income. Household income must be equal to or less than the amounts listed for each pay period |
for your child to be eligible for the scholarship. You will need to present documentation verifying your income. |
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Tier 1 (Fees Covered) |
Tier 2 (Fees Covered) |
Tier 3 (Fees Covered) |
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Scholarship 75% / 25% Participant |
Scholarship 55% / 45% Participant |
Scholarship 35% / 65% Participant |
Household Size |
Annual Income |
Annual Income |
Annual Income |
1 |
$16,744 |
$23,828 |
$30,912 |
2 |
$22,646 |
$32,227 |
$41,808 |
3 |
$28,548 |
$40,626 |
$52,704 |
4 |
$34,450 |
$49,025 |
$63,600 |
5 |
$40,352 |
$57,424 |
$74,496 |
6 |
$46,254 |
$65,823 |
$85,392 |
7 |
$52,156 |
$74,222 |
$96,288 |
8 |
$58,058 |
$82,621 |
$107,184 |
each additional |
$5,902 |
$8,399 |
$10,896 |
family member add: |
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add |
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Income is defined as any monies earned before any deductions such as income taxes, social security taxes, insurance premiums; |
charitable contributions, and bonds. It includes the following: (1) Monetary compensation for services, including wages, salary, |
commissions or fees; (2) net income from non-farm self employment; (3) social security; (4) dividends or interest on |
savings or bonds or income from estates or trusts; (5) net rental income; (6) public assistance or welfare payments; |
(7) unemployment compensation; (8) government civilian employment or military annuities; (9) private pensions or annuities; |
(10) alimony or child support payments; (11) regular contributions from persons not living in the household; (12) net royalties ; |
and (13) other cash income. Other cash income would include cash amounts received or withdrawn from any source including |
savings, investments, trust accounts, and other resources that would be available. |
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