Day School Scholarship Application

Member Name*

First Last

Member Email*

Children's Names

Child #1	Child #2	Child #3

Children's Ages

Child #1	Child #2	Child #3

Child 1 - School Attending:

Child 2 - School Attending:

Child 3 - School Attending:

Parents Will Pay:

Child #1	Child #2	Child #3

2018 Gross Earnings

Total number of children in family:

Please attach a statement of any extenuating circumstances.

Scholarship Information

You must apply for aid to the institution(s) indicated below before your application will be considered by NSSBE.

Have you applied to the school for a scholarship?

Has the school responded?

What amount of money was awarded?

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