HOUSTON' CHILDREN’S'CHORUS'
APPLICATION'FOR'FINANCIAL' ASSISTANCE'2019-2020'
Financial'grants 'will'be'awarded'on'an'equitable'basis.'Financial'assistance'cannot'be'considered'unl ess'
you'provide'the'information'and'documentation're quested'b elow.'All'information'will'b e 'kept'strictly'
confidential'and'available'to'only'the'Financial'Assistance'Committee'of'the'Board'of'Directors.'
Questions'regarding'the'program'or'the'application'should'be'directed'to'the'Chorus'offi ce'at
713-650-3800.''Parents'of's cholarship'recipients'are'requested'to'donate'thirty'hours'of'volunteer'work
for'the'Choru s'when'requested'during'the'school'year.'''CHOIR:''''Prep________'''Concert________
Please'P RINT'or'TYPE'all'information.''Seeking:'Full___''''Partial___'Payment'Terms_____'
Student’s'Name:'______________________________________________________________________________________________________'
(First)'' ' ' (Middle)' ' ' (Last)'
School'(Fall'2018)'_______________________________________ ___'School'District'_______________________________________'
Home'Address'________________________________________________________'City'_________________________' Zip'____________'
Father’s'Name'______________________________________________________'' Home'Phone'_________________________________'
Father’s'Employer'_________________________________________________'' Work'Phone'_________________________________'
Mothers'Name'_____________________________________________________' Home'Phone'_________________________________'
Mothers'Employer'________________________________________________' Work'Phone'_________________________________'
Mothers'Email_____________________________________________ _'Father’s'Email________________________________________'
Number'of'dependent'children'in'family'__________'
Total'i ncome'reported'on'line'37'of'the'Form'1040'or'on'line'21'on'Form'1040A:'$____________________'
If' applicant' doe s' not' file' a' 1040'or' 1040A,' list' all'sources' and' amount' of' income' (such' as' child' support,'
public' assistance,' and' social' security)' and' attach' documentatio n.' Indicate' any' MAJOR' or'
EXT RAORDINARY'family'medical'or'educational'expens es .'
_________________________________________________________________________________________________________________________'
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________'
Please' attach' a' separate' sheet' detailing' any' other' pertinent' information' that' you' feel' may' aid' the' Committee' in'
making' its' decision.' ' Please' return' this' completed' form' and' a' copy' of' your' mo st' recent' Federal' Tax' form' or'
alternate' documentation' to' Houston' Children’s' Chorus,' Financial' Assistance' Committee,' at' P.O.' BOX' 66567,'
HOUSTON,' TX' 77266-6567.' ' To' be' considered,' applications' must' be' received' by' July' 1,' 2018.' Current' Chorus'
members' are' required' top' submit' application' by'June' 1,' 2018.' You' will' be'notified' by'e-mail' of' the' Committee’s'
decision'(no'publ ic' announcement).''
“I'hereby'affirm'that'the'above'information'and'documentation'are'true'and'correct'to'the'best'of'my'knowledge.'
If'my'child'is'accepted,'I'am'obli gated'to'participate'in'the'ENTIRE'season'(through'July'31,'2018).'If'for'any'
reason'I'choose'to'terminate'membership,'I'am'obligated'to'pay'the'remaining'tuition'cost'for'the 'season.”'
Parent’s'Signature'________________________________________________________________________'Date'________________________________'
Print' Name'______________________________________________________________'
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