COVID-19 Emergency Financial Aid Application PARENT 1 NAME:* First Last PARENT 1 EMAIL:* PARENT 2 NAME: First Last PARENT 2 EMAIL: STUDENT NAME(S):*HAVE YOU INCURRED AN INCOME DISRUPTION RELATED TO THE COVID-19 PUBLIC HEALTH EMERGENCY?*YESNOANNUALIZED EARNINGS AS OF DECEMBER 31, 2020* ESTIMATED ANNUALIZED EARNING FOLLOWING INCOME DISRUPTION:* EXPLAIN COVID-19 PUBLIC HEALTH EMERGENCY INCOME DISRUPTION:*HAVE THERE BEEN ANY MATERIAL CHANGES TO YOUR FAMILY'S EXPENSES OR ANY UNUSUAL FINANCIAL EVENTS RELATED TO THE COVID-19 PUBLIC HEALTH EMERGENCY?*YESNOEXPLAIN COVID-19 PUBLIC HEALTH EMERGENCY EXPENSES OR UNUSUAL FINANCIAL EVENTS:*WHAT DO YOU FEEL YOU COULD AFFORD TO PAY ON A MONTHLY BASIS?* IS THERE ANYTHING ELSE THE FINANCIAL AID COMMITTEE SHOULD KNOW?This form is for emergency financial aid determinations only, which are related to the COVID-19 public health emergency, for the 2021-2022 school year only. Two household families need to complete a form for each household.
