2024 Governor's School of Tennessee Need-Based Scholarship Application

There are a limited number of Need-Based Scholarships available for those who qualify.

Application and record of benefits must be submitted by April 12, 2024,
to be considered for this scholarship.

You will need to have the following information to complete the application.

Please only send/attach the requested information as directed.

1. Letter of Request (Included on this form)

2. Completed online application (included on this form)

3. 2023 Federal Income Tax Return (IRS 1040, 1040A, 1040EZ) - DO NOT SEND

4. 2023 W-2, recent pay stub - DO NOT SEND

5. 2023 untaxed income records (Child support received, worker’s comp.) - DO NOT SEND

6. Current Bank Balance (Checking, Savings, Other) - DO NOT SEND

7. Record of benefits received from any of the Federal Programs

(please attach at the appropriate location):

Supplemental Security Income (SSI). Food Stamps
Temporary Assistance for Needy Families (TANF)
Special Supplemental Nutrition Program for Women, Infants & Children (WIC)

*Note: Need-based scholarship awards will be determined based on the information provided in the application and supporting documentation if required.

LETTER OF REQUEST FOR NEED-BASED SCHOLARSHIP ASSISTANCE

I/we are applying for a Need-based Scholarship for our son/daughter to attend the 2024 Governor’s School for the Arts program.

Requested Amount Of Scholarship: *

I/we would like to be considered for financial assistance for the: *

Program Cost ($2850.00)

Activity Fee ($350.00)

Both ($3200.00)

Student Last Name *

Student First Name *

Name(s) of Parent/Guardians: *

Mailing Address or PO Box *

City *

State *

Zip Code *

Primary Phone Number *

Secondary Phone Number *

Parent/Guardian Email Address *

What is the student's family's approximate annual household income? *

What is the amount the family can contribute to the cost of the program? *

Please write a short narrative of any information that might be pertinent in the consideration of financial need? (optional)

Signature of Parent/Guardian *

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Date * +

APPLICATION FOR NEED-BASED SCHOLARSHIP ASSISTANCE

Student's Last Name *

Student's First Name *

Name of Mother

Mother's Place of Employment

Name of Father

Father's Place of Employment

How many people live in your household? (include parents, children only) *

In 2023 did anyone in the household receive benefits from any of the following Federal programs listed? (Check all that apply) *

Supplemental Security Income (SSI)

Food Stamps

Temporary Assistance for Needy Families (TANF)

Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)

N/A

Please upload a copy of the federal benefits here:

What income tax return did you file or will file for 2023? *

What was your Adjusted Gross Income (AGI) for 2023? * 🛈

How much did the mother earn from working in 2023? *

How much did the father earn from working in 2023? *

As of today, what are your current monthly expenses? *

By signing this application you agree, if required, to provide information that will verify the accuracy of the information on this form. *

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Date * +