Who may apply Thank you for your interest in Children’s Scholarship Fund- Charlotte (CSF-C). The mission of CSF-C is to open the doors of educational opportunity for low-income families in Mecklenburg County by providing access to the independent schools of their choice. CSF-C also offers funding for Homeschooled children. We do this by providing partial tuition assistance to families who meet the following requirements: ● legal residents of Mecklenburg County ● children entering grades Kindergarten - 8th ● children entering Kindergarten or transferring from a public school or homeschool (they did not attend a private school last year unless it was a pre-K program) ● families demonstrating financial need as measured by standards similar to the Federal Free and Reduced School Lunch Program How the scholarships are processed All complete scholarship applications received are processed in a first-come, first-served order. Please reference all instructions required for a complete application. WE ONLY ACCEPT COMPLETE APPLICATIONS that have all required signatures and all required supporting documentation, including any additional information that may be requested after initial review. If you submit an incomplete application it will not be processed. Due to the high volume of applications received we do not provide “status checks” on applications. How to submit an application We DO NOT accept applications by fax. You may submit your application by mail or bring it to Foundation For The Carolinas at 220 North Tryon, Charlotte, NC 28202 and leave it with the receptionist in the front lobby. If you bring in your application, please be advised that we will not be available to meet you to discuss your application due to the time constraints during application cycles. If you have questions please submit them by email for the most expedient reply. Upon review of your application, additional information may be requested. Your prompt reply will be needed to avoid delay in processing your application. Resources If you are interested in finding a school list or have questions regarding Homeschooling, please visit the North Carolina Department of Administration Division of Nonpublic Education web site at www.ncdnpe.org. Thank you for your interest in CSF-C and we wish you success! For Your Information Only NOTE: DO NOT RETURN THESE FORMS TO CSF 2014-2015 Income Eligibility Scale *Maximum Income Based on Total Annual 2013 Income House size Maximum Eligible Income* Two $41,877 Three $52,731 Four $63,585 Five $74,439 Six $85,293 Seven $96,147 Eight $107,001 For Each Additional Family Member Add $10,854 Note: Please note the scholarship amounts vary depending on the family’s income, household size and the school’s tuition cost. The highest scholarship amount for independent schools for 2014-15 will be $2,500 per child. Families will be required to contribute partial tuition ($500 minimum per family) towards their child’s education. The highest scholarship amount for Homeschoolers is $500 per child (and the $500 minimum requirement does not apply). For additional information about our scholarship guidelines and program eligibility requirements, please visit our website: Failure to complete any of the steps for the application will delay or deny the processing of your application. Helpful Application Checklist NOTE: DO NOT RETURN THESE FORMS TO CSF Please make sure you have done the following to submit a COMPLETE application for processing: □ I filled in all blank spaces that is required information asked for on the application forms and I SIGNED and dated all forms where indicated □ The number of household members on my application form agrees with the number of dependents on my 1040 Federal Income Tax Return □ I provided legible documentation verifying all my household income sources, including: □ 2013 Federal Tax Return signed on page 2, and the tax return of the person claiming my child as their dependent if other than myself □ Section 8 Housing Assistance or other Public Assistance- I provided all benefit statements for January through December 2013, including the statement listing the names of persons in my household □ Food Stamps/ SNAP/EBT- I provided all the benefit statements for January through December 2013, or I requested a printout from the agency reflecting the same, including the page listing the names of persons in my household □ Child Support and Alimony- I provided a legible and unaltered copy of the official court-ordered support, or deposit statements, or other notarized documents showing payments received for January through December 2013 □ Social Security/SSI/Disability benefits- I provided legible and unaltered copies of official benefit statements or letters for all family members in my household who received benefits from January through December 2013 □ Unemployment benefits- I provided legible and unaltered copies of official statements including the benefit periods and the amounts received in 2013 □ Worker’s Compensation- I provided legible and unaltered copies of official statements including the periods and the amounts received in 2013 □ Other government assistance- I provided legible and unaltered copies of official statements including the benefit periods and the amounts received in 2013 □ Financial assistance from family or friends, etc. - I provided a notarized statement or document indicating the periods and amounts I received in 2013 □ If I did not file taxes, then my application has been notarized where indicated, and I have provided all income verification as required □ I made copies of my application pages and income documents to keep for myself □ Where a known issue exists, such as a change in employment or income or household size since 2013, please provide a short letter of explanation with your application so we can further discuss your individual situation if necessary. □ You will be notified if any addition information is needed for your individual circumstance. If you do not have all of the documentation required to complete your application, your application cannot be processed. □ All scholarship recipients will receive an annual survey to be completed by its stated deadline. This survey is mandatory for all scholarship recipient families, and scholarship awards are subject to be placed on HOLD or denied/terminated for failure to complete and return this mandatory document. Agreement to complete this survey and any other program requirements is part of the Terms of Agreement for your participation in our program. Additional Information For Homeschoolers Only □ I included a completed W-9 with my application □ I included a copy of my NC State Registration for my Homeschool (“Intent to Operate a Homeschool”) or other official document that shows my Homeschool is legally registered and operating in the state Documentation Requirements: Please read through the Instructions carefully. Household defined-A “household” includes all persons living at the same address and/or all persons for whom the head of household claims financial responsibility; all persons for whom the recipient’s resident guardian claims financial responsibility; and all persons claiming financial responsibility for scholarship recipients, even if the recipients do not reside with him or her, along with all other persons for whom that person claims financial responsibility. If a child is not claimed on your 1040 tax forms or budget letter, you must provide proof of guardianship (i.e. court papers) and the 1040 tax forms or budget letter from the person claiming the child. You must list all sources of income. You must report the TOTAL YEARLY AMOUNT and document all income! If you and your spouse filed taxes jointly, you may list the total amount. Include the income of others that provide support or have claimed the child/ren as dependents. Explanation of Income Sources*: Adjusted Gross Income – Found on line 37 (1040) or line 21 (1040A). The 1040 tax forms are found in the package that was given to the individual by the tax preparer. Any child/ren who are not claimed by the parent applying must send in the income information of the parent/guardian who claimed the child/ren. PLEASE MAKE SURE THE SECOND PAGE OF THE 1040 IS SIGNED. Include only the first two pages of the 1040. If the parent/guardian DOES NOT have a 1040, contact the Internal Revenue Service at 1-800-908-9946 and request a transcript. Child Support & Alimony Income – Provide official court ordered documents citing the amount being received. If child support is not court ordered, a notarized document written by the person providing the support is required. The letter should include the total amount given to the parent and must specify if given yearly, weekly, or monthly. Public Assistance Cash & Food Stamp Income – This is found on a budget letter or notice of food stamp benefit you receive. A budget letter is a printout obtained at the public assistance office showing the cash amount and/or EBT benefit the individual is receiving. To obtain a copy of the amount of benefits received for 2013 please contact your assigned food stamp office and request a statement of benefits received for January through December 2013. They will not fax the information to you. Social Security Income – Provide official SSA-1099/SSI letters for all family members receiving SSA Benefits, SSI, and/or Disability. Unemployment & Worker’s Compensation Income – Unemployment compensation is includible in gross income. You must report unemployment compensation on line 19 of Form 1040, line 13 of Form 1040A, or line 3 of Form 1040EZ. If you do not claim your award on your taxes, you are required to submit the 1099G form (award letter). Other Income – If you do not file taxes, but work, you must provide a notarized letter from your employer stating your total annual income. If you are receiving assistance from family/friends, you must provide notarized letters written by the person providing the support. The letter must state the annual amount given to you. If you are a FOSTER parent, an official letter from the Aid to Families with Dependent ChildrenFoster Care Program (AFDC-FC) must be submitted. No applicant can claim “0” (zero) income on the application. If you did not file taxes, you must get the income declaration form notarized! Please sign your name and date the page to certify all information is accurate. All income documentation is still required. School Commitment Form: This form is included in the application packet. Please have the school administrator at the school your child will attend complete this form. Complete one form per child. The tuition information must be provided by the school. Please remind the school to send us a copy of their tuition schedule when they return the form to us. This form is due with your application. Notify CSF-C if this form cannot be completed by the deadline. A “complete application” includes the School Commitment Form. This form will be completed by the school upon your child’s enrollment at the school. Some flexibility will be allowed- for a period of time- if you have not yet selected a school. However, your scholarship award will not be calculable or held until this determination has been made. Other completed applications will continue to be processed, and your award cannot be guaranteed until your child is enrolled and we receive this form, provided funds remain available. If you are a Homeschooler please download the Homeschool Commitment Form in your packet. This form must be notarized, and appropriate documentation of state law compliance must be attached (a copy of NC state homeschool registration or ‘Intent to Operate Homeschool” that you filed with the state of NC upon registering your Homeschool). IRS Form W-9 is required of the administrator of the Homeschool. *All income sources and benefit statements required are to be from 2013 (January – December). Current information will be requested on a case by case basis. You may advise us if your financial situation has changed since 2013. Send Completed Forms To: Children’s Scholarship Fund-C 220 North Tryon St. Charlotte, NC 28202 Questions? Email [email protected] or visit www.csfcharlotte.org *** This form does not guarantee a scholarship. Registration Application 2014 APPLICATION DEADLINE: May 30, 2014 PARENT/GUARDIAN INFORMATION: Complete for each parent in your home* Marital Status (check one): Last Name: First Name: Middle Initial: □Single □Married □Divorced □Separated Mailing Address: City: Apartment Number: State: Home Phone: Zip: Work Phone: County: E-mail Address: Cell Phone: Relationship to child/ren (check one): Note: A copy of official custody documents must be on file for all designations other than “Mother” or “Father” or “Stepparent” □Father □Mother □Stepparent □Grandparent □Foster parent □Guardian PARENT/GUARDIAN INFORMATION* Last Name: First Name: *The first parent listed on this form will be our primary contact and the person who will be required to sign most documents related to the CSF-C program. Middle Initial: Mailing Address: City: Alternate Phone: Marital Status (check one): □Single □Married □Divorced □Separated Apartment Number: State: Home Phone: Zip: Work Phone: County: E-mail Address: Cell Phone: Relationship to child/ren (check one): Note: A copy of official custody documents must be on file for all designations other than “Mother” or “Father” or “Stepparent” □Father □Mother □Stepparent □Grandparent □Foster parent □Guardian Alternate Phone: *The first parent listed on this form will be our primary contact and the person who will be required to sign most documents related to the CSF-C program. STUDENT INFORMATION Please list below all children for whom you are applying for a CSF-C scholarship. Only children entering grades K-8 are eligible. Add additional sheet if needed. Child 1 First & Last Name Date of Birth Boy or Girl? Relationship to Guardian School child attended in 20132014 school year Grade Level in 2014-2015 Child 2 Child 3 Child 4 VERIFICATION Conditions of Eligibility: By initialing these boxes, I understand the following conditions must be met in order to maintain a CSF-C scholarship: I promise to pay my child’s school account in a timely manner. I will ensure at least 90% school attendance of my child(ren), and comply with the policies and procedures and standards of my child(ren)’s chosen school. I understand that it is the responsibility of the parent/guardian to resolve issues (i.e., payments, tuition costs, disputes over balances and fees owed to the school) according to the school’s policies and procedures. I understand that students receiving this CSF-C scholarship must continue to be a legal resident of the program area (Mecklenburg County). The students receiving this CSF-C scholarship must be enrolled as a student between kindergarten and 8th grade for fall 2014. I understand that the student receiving this CSF-C scholarship must attend the chosen school for 3 weeks before the CSF-C scholarship payment will be made. I also understand that transferring the CSF-C scholarship recipient after 3 weeks of enrollment may result in a prorated CSF-C scholarship award. I will immediately inform CSF-C of any changes or conditions that could affect our scholarship award or eligibility or the CSF-C program administration. This includes, but is not limited to: my child withdrawing from or transferring schools; any financial aid awards granted by my child’s school or changes in tuition; any changes in my address, phone number, or email; significant changes in my household income or job loss, etc. Parental/Guardian Agreement to Provide Information CSF is interested in maintaining historical data on CSF scholarship recipients in order to evaluate the impact of the program. By initialing this box, I understand if awarded a CSF scholarship, I agree to provide Children’s Scholarship Fund Staff the following: Reasons for withdrawing the CSF scholarship recipient(s) from private school, Christian school or homeschool Yearly updates on the status of the CSF scholarship recipient(s) upon completion of the 8th grade Final update on the status of the CSF scholarship recipient(s) upon completion of high school I understand that failure to comply with the above statements will result in the loss of my family’s scholarship. I certify that all the information provided on this form is true and complete to the best of my knowledge I will ensure that I complete and return the annual Parent/ Student Surveys, and all other required program documentation, by their stated deadlines. VERIFICATION Parental/Guardian Agreement to Provide Information: CSF-C is interested in maintaining historical data on CSF-C scholarship recipients in order to evaluate the impact of the program. I understand if awarded a CSF-C scholarship, I agree to provide CSF-C staff the following: I agree to allow the school to release grades and standardized test scores for use by Children’s Scholarship Fund “CSF”, in order to allow CSF to evaluate this program. I agree to allow my child’s picture to be taken and used for promotional and fundraising purposes. Finally, I agree to release CSF from any and all liability in its efforts to provide this scholarship. Date Signature of Applicant SIGN HERE DO NOT WRITE HERE, FOR CSF USE ONLY: DATE RECEIVED COMPLETE: AWARD%: _________ RETURNED TO SENDER ON: __________________ SCHOOL: Parent/Guardian’s Name: First Name Last Name Middle Initial or Name Registration Application 2014 All parents or guardians must claim children as dependents and must report their 2013 annual income on this form and attach supporting documentation of that income. Enter all household income information in the table below as annual amounts for 2013. Total number of people in household: Adults _________ Children _________ INCOME SOURCE FATHER MOTHER OTHER Adjusted Gross Income reported on 2013 FEDERAL 1040* Social Security Benefits AFDC/ADC Food Stamps, EBT, SNAP Child Support in 2013 Unemployment (List only if not filed on 2013 tax return) Section 8/Other Public Assistance Any other additional income received in 2013 Total Household Income (Sum of bottom row) TOTAL Individual Income * Please attach a copy of your 2013 Federal 1040 Tax Return with dependents listed and proof of all income from 2013. Married couples filing separately must attach both forms. Failure to document income by the deadline may result in the loss of your scholarship. DO NOT SEND STATE TAX FORMS. For a free copy of your 1040 call the Internal Revenue Service at 1-800-829-1040. Complete this section only if you did not file taxes for 2013 Parents and guardians using a notary must also provide official documentation of all 2013 income, such as public assistance statements, child support documents, and Social Security statements. Space for Notary Stamp Notary signature _____________________________________ Date ____________________________ Notary name _______________________________________ Date ____________________________ I certify that all the information provided on this form is true and complete to the best of my knowledge & I agree to release CSF from any liability in its efforts to provide this scholarship. SIGN HERE _________________________________________________________________________________________________________________ Signature of Parent or Guardian Date SIGN HERE _________________________________________________________________________________________________________________ Signature of Parent or Guardian Date Return To: Children’s Scholarship Fund-C 220 North Tryon Street Charlotte, NC 28202 Phone: 704-973-4534 Fax: 704-973-4934 School Commitment Form 2014 This form MUST be returned with your application by May 30, 2014 for your application to be processed as a complete application PLEASE ATTACH A TUITION SCHEDULE FOR THE 2014-2015 SCHOOL YEAR WITH THIS FORM-- THANK YOU. To be completed by the Principal or Administrator ONLY This is not an application form. It is for use only after a participating student has been accepted to your school. One student per form, please. Please make additional copies as needed. School Information: Name of School ______________________________________________________________________________________________________ S E C T I O N 1 Address ________________________________________ City ______________________ State ___________ Administrator Phone ( ) Zip ________________ Email_________________________________ Student Information: Student Name _______________________________________________________________________ Sex _______________________ Parent / Guardian Name_______________________________________________________________ Relationship __________________ School attended last year ______________________________________________________________ Home Phone ( ) ___________________ Tuition Information: Grade in 2014-2015 school year (If your school does not use traditional grades, please use K for 5-year-olds, 1st for 6-year-olds, etc.):_________________ Start date (first day of enrollment) in 2014-2015 school year: ______________ Total days in 2014 school year: ____________ Annual Tuition for this child (include family discount if applicable; DO NOT include registration, book or activity fees, uniform costs, etc.): $________ Amount of financial aid from your school or sources other than Children’s Scholarship Fund: $ _____________ (annual amount) Please check the appropriate box for each statement below. This student has completed registration and has been accepted for enrollment. This student owes no money for tuition or fees at this school from years past. I promise to report to the scholarship program this student’s attendance. I promise to report to the scholarship program if this student leaves to attend another school. ___ True ___ False ___ True ___ False ___ True ___ False ___ True ___ False TERMS OF AGREEMENT S E C T I O N 2 Our school has accepted this student for enrollment. Our school wishes to participate with the Children’s Scholarship Fund in assisting in the education of the above student. We acknowledge that the Children’s Scholarship Fund’s continued payment is strictly contingent upon the family meeting and maintaining conditions of eligibility, and upon the family remaining current on all fees and tuition payments. We agree to monitor the situation and report to Children’s Scholarship Fund about any conditions that would disqualify the family from participation in the Children’s Scholarship Fund program. Should any conditions occur that would change the amount of award given to the family (e.g. financial aid awards), we will inform the program. We agree to review whatever documentation of eligibility is required for this grant recipient. We understand further that the Children’s Scholarship Fund may, in consultation with a participating school, annually review the status and progress of participating students for the purposes of monitoring and verifying their continued eligibility for participation. Finally, we certify the above information to be correct and agree to the terms outlined. Administrator completing this form_________________________________________________________________________________________ Signature of Principal, Assistant Principal or Equivalent Title Date EMAIL ____________________________________________________________________________________________________________________________________ Signature of Principal, Assistant Principal or Equivalent Title Date DO NOT WRITE HERE, CHILDREN’S SCHOLARSHIP FUND USE ONLY! Scholarship Amount: $ Do Not Return This Page All applications must have the following minimum requirements : Final Checklist: 3- page application, completed and signed on pages 2 and 3. Do not leave any fields blank– enter “N/A” if not applicable. Page 1 and 2 of your 2013 Federal Income Tax Return, signed on page 2. Even if you filed electronically still sign the signature line– both parties must sign joint returns. School Commitment Form About the School Commitment Form (SCF): This form is considered part of a complete application and no scholarship award will be granted without it. It is to be given to the school administrator for completion upon your child’s registration at the school. Applicants are not to complete this form. If you have not registered your child in the school at the time of your application, you will NOT be guaranteed a scholarship award. Applications can only be processed for possible eligibility without the SCF. Once the SCF is completed and submitted, your scholarship award may be granted provided funding is still available. This is the minimum requirement for families who receive NO additional financial support or assistance. If you or anyone in your household receives any type of benefits or assistance, then see all accompany instructions for submitting those required documents. Any application missing this minimum information cannot be processed. Remember, late applications will be added to the first-come, first-served list and are not guaranteed to be processed.
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