Skillshop Scholarship Application

A limited number of Scholarships based strictly on financial need are awarded:

$200 for Weeklong Skillshops and $100 for Weekend Skillshops.

When completing the scholarship application, also complete your Registration form and include the necessary 'place holder' scholarship deposit fee of $150 for Weeklong Skillshops and $75 for Weekend Skillshops.

Please enter NA in any blank field.
ALL fields must be completed to be submitted.

Thank you!!

Which Skillshop do you want to attend? *

First Name *

Last Name *

Address 1 *

Address 2

City *

State *

Postal Code *

Home Phone# *

Cell Phone#:

Email Address *

Number of Dependents: *

Age of Dependents: *

Monthly Income Information *

	Answer
Employer's Name	Answer
Monthly Net Income	Answer
Spouse Employer's Name	Answer
Spouse's Monthly Net Income	Answer
Other Sources	Answer
Other Sources	Answer

TOTAL MONTHLY INCOME: *

Monthly Expenses (please list all expenses on a monthly basis) *

	Answer
Rent/Mortgage	Answer
Car Payment/Car Insurance & Expenses (all)	Answer
Utilities & Telephone	Answer
Loans	Answer
Medical Insurance & Expenses	Answer
Food	Answer
Other Expenses	Answer
Other Expenses	Answer

TOTAL MONTHLY EXPENSES: *

Comments:

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Once you click submit it will be sent to us electronicaly. If you like, you can print this form and FAX or mail it to the office address below:

S.E.E. Center for the Advancement of Deaf Children
PO Box 1181
Los Alamitos, CA 90720-1181

FAX: (562) 795-6614