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CYC Scholarship Application Form
   
Type of application:
Student Information  
First name:
Last name:
Parent/Guardian Information
First name:
Last name:
   
Street address:
City:
State: Zip code:
Phone number: -
Office/Work number: -
Mobile number : -
Email:
   
Are you a CYC Member? Yes  No
   
Application Questionnaire
1. Is your financial situation permanent?


2. Are you a single or multiple income family?

3. Have you attached a copy of proof of income?

For scholarship consideration you must include proof of income to be considered. If multiple family income, all income copies for each provider must be sent to CYC.  
4. Do you own or rent your place of residence? Please check one.

5. What is your total income per year? US$
For scholarship consideration you must include your total household income per year (actual $ amount).
6. Please list your occupation and employer?
   Spouse occupation/employer?
7. Do you receive income from any other source (i.e. child support, welfare, etc)?

Yes No

8. Does your child receive free or discounted lunches at school? Yes No
9. How many dependents under the age of 18 do you have living in your household?
    Do you have any dependents not living with you? Yes No
    How many?  
10. What CYC fees are you requesting financial assistance with?  
    

 
     If other, please explain:

11. How much of the required fee could you pay? US$
12. Please briefly describe why you are in need of scholarship?  

13. Would you be willing to volunteer at the CYC? Yes
     If No, please explain:

     If Yes, please let us know any particular areas you can help:

 
 

Note: All information will be kept confidential. CYC reserves the right to terminate scholarships at any time.

Terms of the CYC Scholarship Policy
The CYC scholarship committee meets once a week on scholarship decisions. The CYC reserves the right to discontinue a scholarship at any time. Partial scholarships may be awarded based on the decision by the CYC scholarship committee. Scholarships will normally be reviewed on an annual basis.
 
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