PARENT EDUCATION PROGRAM/PARENT ADVISORY COUNCIL
SCHOLARSHIP APPLICATION FORM
Scholarships are awarded on the basis of financial need to those families who could not otherwise afford to participate in a Parent Cooperative experience or to those experiencing a temporary financial emergency.
Date _______________________ Quarter applied for ______________________________
AM
Co-op name __________________________________ PM Age group ____________
N.S.C.C. Parent Education Instructor’s Name _____________________________________
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Child’s Name _______________________________________ Age ______________
Address _________________________________________ Telephone _____________ (area code) Parent’s Name _______________________________ Occupation __________________
Currently Employed ____________________ Full-time __________ Part-time _________ hrs/wk Parent’s Name _______________________________ Occupation __________________
Currently Employed ____________________ Full-time __________ Part-time _________ hrs/wk Parent’s address if different from child’s _________________________________________
Number of children in family _________ Ages __________ School Placement __________ Public _____ Private _____
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Treasurer: Please complete this portion.
_______________________ ____________________ ‘s monthly tuition is ____________ Co-op name Age group
Please exclude extended days, pro-rated May/June, registration fees, etc. and sign below to verify tuition and enrollment of applicant in the co-op program. Awards will be sent directly to the treasurer, so please print your address and phone number.
________________________________________________ ___________________ Treasurer’s signature Telephone
_________________________________ _________________ _______________ Address City Zip Scholarships are typically limited to 50% of monthly tuition, with above noted exclusions. ½ month tuition $ ______________________ X 3 = ______________________ Total quarter request |
(Some families may qualify for up to 75% of tuition, based on NSCC income guidelines and PAC Scholarship Funds available. The Parent Educator notifies the scholarship committee, treasurer and student if the student’s income qualifies the family for NSCC quarterly tuition waiver eligibility.)
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PLEASE USE SEPARATE FORM FOR EACH CHILD |
The following information is necessary to determine need and will be held in the strictest of confidence.
NET INCOME FIXED MONTHLY EXPENSES
(monthly take-home pay)
Salary ____________ Rent/Mortgage ________________
Rents rec’d ____________ Utilities ________________
Alimony ____________ Food (Avg. Amt.) ________________
Child Support ____________ Insurance (car, health, life) ________________
Interest/ Vehicle, gas, bus ________________
Dividends ____________ Credit Cards ________________
Other ____________ Loans ________________
Medical, Dental ________________
Other/please list (diapers
clothing, toiletries) ________________
Preschool tuition ________________
TOTAL MONTHLY INCOME $_______________ TOTAL MONTHLY EXPENSES __________
Total number of family members living in home __________
Please describe the circumstances which make tuition assistance necessary. If additional space is needed, please use another page.
Total quarter request ____________________ ____________________________
(not to exceed amount Signature of enrolled parent
in treasurer’s section)
Applications are due AT NSCC by*: Mail to: Scholarship Committee
3rd Friday of Sept. for Fall Qtr. Parent Education program
1st Friday of Dec. for Wtr. Qtr. NSCC
1st Friday of Mar. for Spr. Qtr. 9600 College Way N.
Seattle, WA 98103
* Timely Applications will be considered for available funds. Late applications may be considered if additional funds are available.
Parent Education Instructor: Please comment on applicant’s involvement in the co-op and/or expand on the family situation to support the need for scholarship assistance.
____________________________
This family qualifies for tuition waiver: ________ Instructor’s Signature
(yes or no)
Revised 11/08