City Leadership School Financial Assistance Form Name * Please include middle name with first name, if applicable. First Name Last Name The City Leadership School cost is $5,500 for full-time students. How much funding are you requesting? * (up to 50% of funding could be available to full-time students) $ Are you currently living with your parent(s) * Yes No If yes, have they committed to pay a portion of your schooling? Yes No If so how much? $ Student Marital Status * (check one of the following) Single Married or remarried Separated Divorced or Widowed Do any of the following apply to you? (check all that apply) I am married I am serving on active duty in the U.S Armed Forces Since I turned age 13, both of my parents were deceased I was a dependant or ward of the court since turning age 13 I was a dependant or ward of the court since turning age 13 I am currently or I was an emancipated minor I now have or will have children for whom I will proved more than half of their support between July 1st, 2023 and June 30, 2024 I have dependents (other than children or my spouse) who live with me and I provide more than half their support I am currently or I was in legal guardianship I am homeless or I am at risk of being homeless Student Income Information How much did you earn from working in 2022? * $ How much did your spouse earn from working in 2022? $ In 2022, did anyone in your household receive: (check all that apply) Medicaid Free or reduced price school lunch Supplemented Security Income (SSI) Temporary Assistance for Needy Families (TANF) Supplemental Nutrition Assistance Program (SNAP) Special Supplemental Nutrition Program for Women, Infants and children (WIC) Did you or your spouse have any of the following in 2022? (check all that apply) Additional Financial Information American Opportunity Tax Credit or Lifetime Learning Tax Credit Child Support Paid Taxable earnings from work-study, assistantships or fellowships Taxable college grant and scholarship aid reported to the IRS as income Combat pay or special combat pay Cooperative education program earnings Untaxed Income Payments to tax-deferred pension and retirement savings plans Child Support received IRA deductions and payments to self employed SEP, Simple and Keogh Tax exempt interest income Untaxed portions of IRA distributions and pensions Housing, food and other living allowances paid to members of the military, clergy and others Veterans noneducation benefits Other untaxed income not reported, such as workers’ compensation, disability benefits, or untaxed foreign income not earned from work. Thanks for submitting this form! Your information has been received, and we’ll be in touch, soon. In the meantime, feel free to browse our site and get to know more about our church.
