2022 Financial Assistance form

Financial Assistance Application

80th Traditional Session July 16 - August 6, 2022
A. ABOUT YOU
Full Name *

Prefix First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Phone Number *

Area Code Phone Number
E-mail *
Are you currently a student? *
Check One *

Full-time Part-time
School: *
Are you financially independent (receiving no support from your family)? *

Yes No
If you are not financially independent, please fill out section B. If you are independent, please include copies of the first page of your 1040 Income Tax Forms for the past two years with this application.
B. FAMILY FINANCIAL INFORMATION
Mother's Name:

Prefix First Name Last Name
Employer:
Annual Salary:
Father's Name:

Prefix First Name Last Name
Employer:
Annual Salary:
Income from other sources:
Total family Income:
Number of persons supported by above income:
Please include copies of the first page of your parents' 1040 Income Tax Forms for the past two years with this application.
C. FINANCIAL REQUEST
The cost for the 2022 three-week Traditional Session is $3,000.00.
What amount of the cost do you feel you can pay? *
Please list factors that affect your ability to cover the cost *
Should be Empty:

Financial Assistance Application