Korean Community Services (KCS) Youth Orchestra SCHOLARSHIP APPLICATION FORM

Transcription

1 Korean Community Services (KCS) Youth Orchestra SCHOLARSHIP APPLICATION FORM This applica on form must be submi ed along with a complete registra on form, a non refundable applica on fee, as well as a copy of your 2017 FEDERAL tax return by Monday, September 17 th. Late and incomplete applica ons will not be considered. For any addi onal ques ons, please feel free to call our main office at (718) Parental (Legal Guardian) Information Name: Father Mother Legal Guardian Age: Married Single Home Address: Primary Phone: Address: Employer Name: Occupa on: Work Address: #Years Employed: Work Phone: Name: Father Mother Legal Guardian Age: Married Single Home Address: Primary Phone: Address: Employer Name: Occupa on: Work Address: #Years Employed: Work Phone:, NY 11358, NY 11358

2 Dependents Living at Home Number of children: Number of dependent children living at home: Number of students enrolling in KCS Youth Orchestra Program: Name Age Grade School Financial Information Annual Income Total Annual Income from 2017 tax return form 1040 line 37 or form 1040a line 21 Previous Year Jan Dec, 2017 Current Year Jan Dec, 2018 Explain any significant changes in income for the current year in the space below, NY 11358, NY 11358

3 Expenses 2017 Annually ed 2018 Annually Rent Mortgage (Interest & Principal) Real Estate Taxes U li es Income Taxes (net a er refund) Alimony/Child Support Synagogue or Church Dues/Contribu ons Tui on (less assistance received) Private School Tui on Paid Summer Camp Tui on Paid Music School Tui on Paid Other school tui on paid Insurance Premiums paid by you (including home, life, auto, medical, etc.) Unreimbursed medical, dental expenses Auto Loans/Lease (total all cars) Loan repayments (total for all other loans) Child Care, Domes c Help Living Expenses (total for food,clothing, etc.) Vaca ons Other unusual expenses (please explain) Total Expenses Total Income less Total Expenses Explain any significant changes in expenses for the current year in the space below:, NY 11358, NY 11358

4 Assets Cash and Other Liquid Assets Cash (total checking/savings/cds, etc.) Marketable Securi es (stocks, bonds, mutual funds, etc.) Total Cash Securi es Real Estate Current Market Value Purchase Price Year Purchased Mortgage at me of purchase Secondary Residence Current Market Value All Other Real Estate Total Real Estate Motor Vehicles Purchase Price Current Value Make/Model/Year : Make/Model/Year : Total Value Motor Vehicles: Total Assets (other than business): Business Assets 2017 ed 2018 Name of Business: Nature of Business: Gross Revenue Net Revenue, NY 11358, NY 11358

5 Liabilities Please list current amount outstanding for each item Current Balance Primary Residence Mortgage Other Mortgages Home Equity Loans Auto/Bank Loans Other Non Bank Loans Credit Card Loans/Debt Other Debts (list): Total Liabili es (other than business) Additional Information Are there any other aspects of your personal/family financial situa on, which would be useful in helping the commi ee make its decision? Please explain below., NY 11358, NY 11358

6 Signature I declare that the informa on contained in this form as well as any other documents submi ed along with it, is to the best of my knowledge and belief, is true, correct, and complete. I understand that any scholarship may be revoked in the event of misrepresenta on or change in circumstance. Full Name (Print): Signature: Rela onship to student: Date:, NY 11358, NY 11358