Financial Aid Form

Chautauqua Summer Schools Financial Aid Application

Which program are you applying for? ( * required )

Did you live in your parent(s)' home for more than six

Art (**see below regarding 1040 forms)

weeks in the past year? Yes No

Dance (Apprentice and Festival)

Do your parents list you as a tax exemption on their

Dance Workshop 1

Federal Income Tax return? Yes No

Dance Workshop 2

Have you received $2000 or more in aid from your parents

Instrumental

in the past year for clothes, medical care, insurance, etc.? Yes No

Piano

Voice

Chautauqua cannot meet the full need of all applicants. Failure to complete this section will cause your application to be incomplete, and you will receive no financial assistance until all information is complete. **ART APPLICANTS - The information in this section MUST be substantiated by a photocopy of your parents', your guardians', or your own IRS 1040 forms, front and back pages, for two of the three most recent tax years.

If you answered NO to all questions A, B, and C, then you may claim yourself financially independent and should submit your own personal information in question 10 below.
If you answered YES to one or more of the questions above, you may not claim yourself financially independent, and you must provide your parent(s)' complete financial information.

I. Total Anticipated Cost
ART	$4065
DANCE (Apprentice and Festival)	$4405
DANCE (Workshop 1)	$2250
DANCE (Workshop 2)	$3645
INSTRUMENTAL	$3865
PIANO	$4415
VOICE	$4465


10.	Father:
	Current Year Est. Gross Income	$
	Previous Year Gross Income	$
	Fed. Inc. Tax paid previous year	$
	Estimated Fed. Inc. Tax paid current year	$
	Mother:
	Current Year Est. Gross Income	$
	Previous Year Gross Income	$
	Fed. Inc. Tax paid previous year	$
	Estimated Fed. Inc. Tax paid current year	$
	Student: (please complete if independent from parents)
	Current Year Est. Gross Income	$
	Previous Year Gross Income	$
	Fed. Inc. Tax paid previous year	$
	Estimated Fed. Inc. Tax paid current year	$

C.	Parent(s)' Contribution to Cost of Program:	$

I.	Anticipated Cost:	A. $
II.	Applicant's Contribution:	B. ($)
III.	Parent(s)' Contribution:	C. ($)
	TOTAL ESTIMATED NEED: A-(B+C)	$

	11. I hereby certify that the information contained in this application is
	substantially accurate and complete. If any change occurs after I submit the
	application, I will notify Chautauqua immediately.


	Applicant's Signature (or Parent's Signature if under 18)	Date
	By Checking this box, I(we) am electronically signing this application.

	The Chautauqua Summer Schools has several scholarships for minority students (i.e. African American, Native American). If you feel you qualify for one of these, please check the box below.

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II. Applicant's Information

Applicant's Name:

First: Last:

1. Financial resources available for coming summer:

Cash on hand

Assistance from family

Other assistance (loans, grants, etc.)

Applicant's TOTAL ASSETS

2. Jobs held in previous year (state amount earned for each job):

3. Total college/university costs in this year (room, board, tuition) :

School

Cost

4. Did you pay Federal Income Tax for this year? Yes No

Amount $

5. Are you or have you ever been the recipient of any financial

aid (scholarships, grants, loans, gifts)? Yes No

If so, name title of award, period covered, source, amount:

6. Are you the recipient of any educational funds from any state,

organization, or individual specifically for your attendance at

the Chautauqua Summer Schools? Yes No

If so, please state the amount:$

B. Applicant's Contribution to Cost of Program: $

III. Parents' Information

Father or Guardian

Occupation

Name of Employer

Mother or Guardian

Occupation

Name of Employer

Other Dependents (include ages, relationships, partial or full dependency):