Confidential Financial Aid Form

We are applying for financial aid due to COVID-19 Job Loss of Income:

Due: September 1 (or May 15 if you are applying for MYAC's Summer Program)

Note: Your application is not complete without a copy of your signed Form 1040 for the last year you filed taxes with all relevant schedules and supporting documents so we can verify key financial information. Be advised that applications will not be processed until we have all of your information.

Student Information

Applicant's Name:

Grade:

Instrument/Voice:

We are applying for:

Ensemble/s:

Summer Program/s:

Parent/Guardian Name

Phone (for communication about this application)

Email (for communication about this application)

Street Address

City

State

Zipcode

INCOME

*Use Form 1040 Line 10 (Taxable Income). You can qualify for up to 50% tuition based on your income.

Total Annual Income: $

Assets

1. Cash, Savings and Checking: $

2. Value of Real Estate: $

Current Mortgage Balance:

Equity in R.E. (value - mortgage bal.):

3. Stocks and Bonds: $

4. Other Investments: $

5. Automobile/s: (make and year)

EXPENSES

Monthly Expenses (divide any annual totals by 12 to calculate monthly expense, please be as specific and accurate as you can be)

Rent/Mortgage: $

Property Taxes: $

Utilities: Electricity, Gas, Water, Garbage, Internet/Cable, etc.: $

Phones: $

Car payments/insurance: $

Auto expense/gasoline: $

Groceries: $

Parent Student Education Loans: $

Out of Pocket Medical Insurance: $

Special Medical Expenses: $

Dental expenses: $

Private Lessons: $

Out of Pocket College/University Tuition for older siblings: $

Other: $

Please Specify

Please do not include instrument purchases or private or home-school expenses.

ADDITIONAL INFORMATION

How much aid are you requesting? $ Specific Amount (not words)

Please explain circumstances that bear on your need for financial aid. Please use specific details if possible (unemployment, health costs or problems, etc.).

NOTE: Financial Aid Applications for the 2023-2024 fiscal year are processed the first week of August. ONLY COMPLETE FILES ARE CONSIDERED. Available financial assistance is reduced 10% each month after September 15 unless a change of circumstances occurs. Should circumstances change during the year, applications are also accepted. Upon approval of eligibility for financial aid, we will prepare or revise your tuition invoice to reflect the award. The portion of tuition not funded by the MYAC Financial Aid Program is the responsibility of the recipient’s parents or legal guardians and must be paid according to normal tuition payment policies. Please contact the MYAC office if you have any questions. Thank you for your cooperation!

Parent Initials that they have read and submitted information requested:

Date

Contact Information