EmailMe Form - ABW Financial Assistance Application

ABW Financial Assistance Application

TO BE COMPLETED BY A PARENT/GUARDIAN (not the participating student).

Our goal is to ensure that every student is given the opportunity to attend the program. Financial assistance is available to families who cannot afford the full $475 registration fee. These funds are provided by our contributors and are limited. To request financial assistance, please completely fill out the information below. If information is missing, the application for financial assistance will not be considered. All financial assistance applications should be submitted as early as possible, but no later than May 30th, 2015, as funds are limited.

Please Note: This form uses ReCaptcha (TM) technology to keep your information safe and strictly confidential.
If you want to apply for Financial Assistance via mail or fax, you can download a fillable pdf at: http://www.wbw.org/alaska_forms.aspx.
CONTACT INFORMATION
Student Name *
First Last
Mailing Address *

Street Address City State / Province / Region Postal / Zip Code Country / Region
Parent/Guardian Name *
First Last
Parent/Guardian Phone *
### - ### - ####
Parent/Guardian Cell
### - ### - ####
Parent Email *
REGISTRATION IN A BUSINESS WEEK PROGRAM
You should apply for financial assistance at the same time you are applying to attend the Alaska Business Week. No payment is due until two weeks after you have been accepted into the program. All applications for financial assistance are treated with confidentiality. Participants who receive financial assistance are enrolled and included in the program with no regard to their financial status.

We also have tools to help you raise funds to help pay your registration fee from family, friends, civic clubs and local businesses at http://www.wbw.org/alaska_forms.aspx.
Registration *
An application for the ABW program has been submitted.
I will submit an application for Alaska Business Week within two days.
INFORMATION ABOUT FAMILY INCOME
Are you (parent) currently employed? *
Yes
No
If yes, where? and How long?
Is your spouse currently employed?
Yes
No
N/A
Total MONTHLY wages of all working adults in household (before taxes): *
$ Dollars . Cents
Other MONTHLY income (Child Support, Public Assistance, Unemployment, etc.) *
$ Dollars . Cents
Number of adults supported by this income: *
Number of dependents supported by this income: *
Does the student qualify for a school lunch program? *
Free / Reduced
No
Do you receive any of the following? (Select all that apply by holding down the CTRL key.) *
Extenuating Circumstances: (Select all that apply by holding down the CTRL key and describe your circumstances in the explanation section.) *
THIS EXPLANATION BY A PARENT IS REQUIRED –
MUST BE COMPLETED BY A PARENT (not the student):
Please explain why you would like to be considered for financial assistance, including any special financial circumstances or extraordinary monthly expenses as selected above. *
Based on your explanation above, how much of the $475 registration fee do you feel your family can pay? *
$ Dollars . Cents
This amount cannot be guaranteed, but will help in our determination of your award. Families are expected to participate by paying a portion of the registration fee.
ACKNOWLEDGEMENT
I hereby acknowledge that all the included information is truthful and accurate to the best of my knowledge. I understand that falsification of any information regarding my financial status will disqualify my student from receiving financial assistance.
Acknowledged by Parent: *
First Last
Date *
MM / DD / YYYY

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Please Note: This form uses ReCaptcha (TM) technology to keep your information safe and strictly confidential.

CONTACT INFORMATION

REGISTRATION IN A BUSINESS WEEK PROGRAM

INFORMATION ABOUT FAMILY INCOME

THIS EXPLANATION BY A PARENT IS REQUIRED –

ACKNOWLEDGEMENT

I hereby acknowledge that all the included information is truthful and accurate to the best of my knowledge. I understand that falsification of any information regarding my financial status will disqualify my student from receiving financial assistance.