Need-Based Tuition Assistance Request Form

(Updated)

The information you provide will be kept strictly confidential. This information is necessary to insure that our limited resources are allocated as fairly and justly as possible. All Tuition Assistance Request forms must be submitted with the most recent Income Tax Return filed with the IRS or other documentation to support the income reported.

Student Name

Date

Ensemble

Student birthdate

Grade

Current School

Primary Family Email (for award notification)

FAMILY DATA

Parent I's Name

Parent I's Address

Parent I's City, State, Zip

Parent I's Mobile Phone

Parent/Guardian I's Work Phone

Parent I's Occupation

Parent I's Employer

Parent II's Name (if applicable)

Parent II's Address

Parent II's City, State, Zip

Parent II's Mobile phone

Parent II's Work Phone

Parent II's Occupation

Parent II's Employer

Student lives with

MotherFatherBothOther

Please specify other

TOTAL number of people living with in household

FINANCIAL DATA

Please include a copy of your most recent Federal Income Tax Return with this application

2024 Adjusted Gross Income (form 1040 or form 1040A)

Please upload your most recent tax return or other proof of income

Click the red "Choose file" button

If you did not file a federal tax return, or have other sources of income such as child support, public assistance, etc., please list them.

Is your child receiving tuition assistance or a need-based scholarship from any other organization(s)? (If yes, please specify)

Please describe below your reasons for requesting tuition assistance. If necessary, attach an additional page to this form.

Please provide any other information that will assist GPYO in assessing your needs (for example, recent periods of unemployment, prolonged illness, significant financial obligations, etc.). Feel free to add additional documentation.

Have you previously received financial assistance from GPYO? If so, please explain.

I hereby affirm that the above information is true and correct to the best of my knowledge. I further acknowledge that any misrepresentation could jeopardize my ability to receive future assistance.

I also understand that, should I receive an award of tuition assistance, I WILL NOT be eligible to receive a tuition rebate based on my volunteer participation.

Parent's Signature

We will do our best to fill requests within our guidelines, but funds are limited. The Scholarship Committee will review your request, and you will be informed of its decision as quickly as possible.

REMEMBER: YOUR APPLICATION CANNOT BE CONSIDERED WITHOUT ACCOMPANYING TAX INFORMATION. IF YOU ARE NOT REQUIRED TO FILE A TAX RETURN, PLEASE INCLUDE AN EXPLANATION ALONG WITH YOUR APPLICATION AS WELL AS ANY OTHER SUPPORTING DOCUMENTS.

Contact Information