Need-based Scholarship Form – American Heritage School

Is your student currently enrolled at American Heritage School - American Fork Campus? (Students are eligible for a scholarship after one full semester of enrollment at American Fork Campus. *

Yes
No (Do not complete the application. Email ahendrickson@ahsmail.com for additional questions.)

Which scholarship deadline are you filing for? *

How many of your children are applying for scholarships? *

Name of Student *

First

Last

Grade Level of Student (Next Enrollment Year): *

Name of Student 2 *

First

Last

Grade Level of Student 2 (Next Enrollment Year): *

Name of Student 3 *

First

Last

Grade Level of Student 3 (Next Enrollment Year): *

Name of Student 4 *

First

Last

Grade Level of Student 4 (Next Enrollment Year): *

Name of Student 5 *

First

Last

Grade Level of Student 5 (Next Enrollment Year): *

Name of Student 6 *

First

Last

Grade Level of Student 6 (Next Enrollment Year): *

If you have more than 6 students in need of scholarships, please enter the First and Last Name and Grade Level in the box below for any students beyond the six listed above.

Parent(s) / Guardian: *

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Email *

Occupation (Parent 1) *

Occupation (Parent 2)

Upload a written letter stating the reason for the request and the family’s current circumstances. *

Name *

First

Last

Birthdate *

Grade *

Name of child's school *

If you have more than 6 dependents, please enter the First and Last Name, Birthdate, Grade, and School Name in the box below for any children beyond the six listed above.

Confidential Financial Information

Do you rent or own your home? *

Rent
Own
Other

County assessed value of home $ *

Amount owed on home $ *

Monthly rent amount $ *

Please explain your living conditions and an estimation of monthly living costs. *

Amount in checking and savings $ *

Amount of other investments $ *

Upon careful consideration of your household income, savings, funds available through family sources such as grandparents, and public funds such as the Carson Smith Scholarship, what is the TOTAL MONTHLY AMOUNT you can afford to pay for your children to attend American Heritage School? Please enter a specific dollar amount and a brief rationale.