Financial Assistance

Student Information

Date*

Student Name*

Address*

Birthdate*

School (if current student)

Primary Email address*

Enter Email Confirm Email

E-mail address is confidential and is the main form of communication for all EMA programs.

Primary Wage Earner’s Information

Name*

Spouse (if different than Secondary Wage Earner)

Primary Wage Earner's Email Address is:*

Same as Student
Different than Student

Primary Wage Earner's Email address*

Enter Email Confirm Email

Primary Wage Earner's Address is:*

Same as Student
Different than Student

Primary Wage Earner's Address*

Occupation

Employer

Phone Numbers

Work

Cell

I need to enter information for a Secondary Wage Earner*

Yes
No

Secondary Wage Earner’s Information

Name*

Spouse (if different than Primary Wage Earner)

Secondary Wage Earner's Email Address is:*

Same as Student
Different than Student

Secondary Wage Earner's Email address*

Enter Email Confirm Email

E-mail address is confidential and is the main form of communication for all EMA programs.

Secondary Wage Earner Address is:*

Same as Student
Different than Student

Address*

Occupation

Employer

Phone Numbers

Work

Cell

Responsible Billing Party and Preferred Address*

Both Earners at above address(es)
Primary Wage Earner at above address ⁯
Secondary Wage Earner at above address

Would you consider your student to be Hispanic/Latino*

Yes, Hispanic/Latino
No, not Hispanic/Latino
Prefer not to answer

Optional: this student information is requested by funding sources. Your help is greatly appreciated.

What do you consider your student's racial heritage to be? (Mark any that apply)*

American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Prefer not to answer

Optional: this student information is requested by funding sources. Your help would be greatly appreciated.

NOTICE OF DIVERSITY, EQUITY, INCLUSION POLICY We at Encore Music Academy (EMA) dedicate ourselves to creating a welcoming environment. That commitment is inseparable from our commitment to diversity, equity and inclusion. Central to our mission is that all abilities, all ages, and all people have full opportunity to thrive. We know diversity is key to individual growth and music education excellence. Our community is stronger when the voices of all people come together without fear. EMA expects that all relationships among persons in EMA will be professional. We work to build a community free of bias, prejudice, discrimination and harassment. It is the policy of EMA to ensure equal opportunity. EMA does not and will not discriminate on the basis of race, color, religion, gender, gender identity, gender expression, age, national origin, disability, marital status, sexual orientation, military status or any other characteristic protected by federal, state, or local laws and regulations.

INCOME, ASSETS AND EXPENSES

1. Please enter your total household Adjusted Gross Income (AGI) for Previous Tax Year*

Copy of tax return or other proof of income is required

2. Please enter your Estimated total household Adjusted Gross Income (AGI) for Current Tax Year*

Copy of tax return or other proof of income is required

3. Non-taxable income – please check all categories that apply to you:*

Social Security Benefits
Unemployment Compensation
Family Gifts or Support
Interest on Tax-Free Bonds
Child Support
Untaxed Portions of Pensions
Welfare
Housing Allowance
Not Applicable

3a. Actual total of Non-taxable income for Previous Tax Year*

3b. Estimated total of Non-taxable income for Current Tax Year*

4. Total Income for Previous Tax Year*

add 1 + 3a (if applicable)

5. Total Income for Current Tax Year*

add 2 + 3b (if applicable)

6. Please include the total number of persons dependent on this income who live in your household*

7. Please indicate the total costs of all dependents attending a higher learning institution for the current school year*

Enter actual amount paid by household after financial aid
Enter N/A if no dependents are in college

8. Enter the number of months the primary wage earner has been unemployed this current calendar year*

If the primary wage earner has not been unemployed, enter N/A (not applicable)

8. Enter the number of months the secondary wage earner has been unemployed this current calendar year*

If the secondary wage earner has not been unemployed, or there is no secondary wage earner, enter N/A (not applicable)

9. Please list any other extenuating circumstances that qualify your need for financial aid (medical expenses, other therapies, etc.):

10. How much can you contribute towards tuition?*

Is this amount*

per month
per semester
per year

SUPPORTING DOCUMENTATION

Please attach a LETTER of request for aid.

Drop files here or

Max. file size: 2 GB.

Please attach a COPY of your most recent federal tax return. If you have no taxable income, please include social security benefits letter(s) or ADC form. If the heads-of-household are in the U.S. on student and/or non-working visas, you must provide appropriate documentation of this status.

Drop files here or

Max. file size: 2 GB.

Please submit documentation supporting any extenuating circumstances which have placed a financial burden on the family.

Drop files here or

Max. file size: 2 GB.

CERTIFICATION*

By checking this statement, I/we certify that all the information reported on or given in support of this financial aid application is complete and accurate.

PRIVACY RELEASE Your financial aid information is confidential and will only be shared by the financial assistance committee of EMA and with other administrative staff who have a legitimate need to know this information. Please note that this privacy release will remain in effect for the duration of your enrollment at EMA if continuing to apply for financial assistance in future years.

Security Question: What is the first letter in Encore?*

Encore Music Academic

Financial Assistance

Student Information

Primary Wage Earner’s Information

Secondary Wage Earner’s Information

INCOME, ASSETS AND EXPENSES

SUPPORTING DOCUMENTATION

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