Request for Financial Assistance

Online Form

The FOTHSCI Board has set aside funds to assist our choir families should the need arise. The Board will review your request and let you know via email if the request has been granted. Please complete this form and click SUBMIT. The information provided in this form will only be submitted to the Choir Director (choirdirector@fothsci.org), President (president@fothsci.org), and Treasurer (treasurer@fothsci.org).

* Required

Student's Name *

First

Last

Date of Request *

mm/dd/yyyy

Address *

Street, City, State, Zip

Phone *

(###) ###-####

Is Student Employed? *

If yes (Student is employed), Employer Name

Parent/Guardian Email Address *

Confirm Email

Student related to a FOTHSCI Board Member? *

Parent/Guardian 1 Name *

Parent/Guardian 1 Occupation *

Parent/Guardian 2 Name

Parent/Guardian 2 Occupation

Amount Requested *

Enter amount in whole numbers (e.g., 100)

Purpose *

(concert apparel, trip, etc.)

Adjusted Gross Income *

Please select the nearest total combined family income for the past year.

Number of siblings *

Age(s) of siblings *

Provide the ages of siblings, if any, separated by commas (e.g., 12, 14, 18). Enter "N/A" if none.

Number of siblings currently enrolled in college *

Please briefly state below the financial circumstances (family or personal) that have led to this application. *

Why are you making this request?

Parent/Guardian Signature *

Enter your full name as your electronic signature. By providing your name, you acknowledge that the information you have provided on this form is correct and true to the best of your knowledge. You further understand and acknowledge that providing incomplete, incorrect or false information may disqualify the student from receiving financial assistance from the FOTHSCI Board.

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