Scholarship Grant Application

Scholarship Grant Application
Name of Parent/Legal Guardian

First NameLast Name
Name of Student

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail
Phone Number
Student Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
UVA eligibility
Number of years student has completed at Unicorn Village Academy
Anticipated graduation date
Interest in Post-secondary
Family’s annual household gross income (subject to verification):
How many adults and children are in your family household?

Tuition assistance currently received (e.g. McKay, Gardiner, and other scholarships)

Are there other dependents with special needs for whom you are financially responsible?
If so, please explain:
Please explain why you are requesting financial aid.
I understand that by submission of this scholarship request, I certify that the statements and other information submitted with this application are to the best of my knowledge correct and complete.
Should be Empty: