Busy Bees Online Scholarship Application – Abbeville Presbyterian Church

Date

Child's Full Name*

First Middle Last

Child's Date of Birth*

Busy Bees program in which child is enrolled*

1K
2K
3K
4K

Primary Parent/Guardian Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Home Phone*

Cell Phone*

Email*

Place of Employment*

Monthly Income*

Work Phone*

Additional Parent/Guardian Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Home Phone*

Cell Phone*

Email*

Place of Employment*

Monthly Income*

Work Phone*

Child lives with:*

Mother
Father
Both

Household size: Number of adults*

Household size: Number of children*

Total Family Annual Income (including all members contributing to the income of the household):*

Do you or anyone in your household receive additional financial assistance from any of the following? (please enter the approximate monthly amount)

Unemployment

Alimony

Child Support

Social Security

Please explain any special financial circumstances affecting the family’s budget at this time.*

Please explain how you feel financial assistance for preschool would benefit your child and family.*

Are you able to contribute any finances to your child’s tuition?*

Yes
No

How much can you contribute toward your child's tuition?*

Is your child's enrollment at Busy Bees Preschool contingent upon the receipt of scholarship funds?*

Yes
No

Do you have a family/friend benefactor who assists you with tuition?*

No
Yes

If a family/friend benefactor assists you with tuition, please provide more information on this arrangement:

Note: Should scholarship funds not be available, the $115 registration fee will be refunded if the parents desire to have the child removed from the enrollment list.

Authorization*

By checking this box, I hereby certify that all the information contained in this application is true and correct. In addition, I will supply a copy of my most recent income tax returns to the Busy Bees office. I understand that any misrepresentation of the information contained in this document does constitute fraud and will, therefore, deem this application null and void.

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