Skillshop Scholarship Application

A limited number of $200 scholarships based strictly on a financial need are awarded 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. These fees are $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!!

* First Name

* Last Name

* Address 1

Address 2

* City

* State

* Postal Code

* Home Phone

Work Phone:

* Email Address

* Number of Dependents:

* Age of Dependents:

* Monthly Income Information

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

* TOTAL MONTHLY INCOME:

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

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

* TOTAL MONTHLY EXPENSES:

Comments:

0/255 characters

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

* Indicates Response Required


Powered by FormSite.com