Arts on the Hudson
282 Barrow St., Jersey city, NJ 07302
(201) 451-4862
www.artsonhudson.tripod.com

SCHOLARSHIP APPLICATION


Date:


Student Name ____________________________________ Grade__________________

Yearly Gross Household Income $____________________

€ You must attach one copy of last year’s W-2 Form, or copy of recent payroll or welfare check stub
(Please refer to Income Limits at bottom of page to determine eligibility)
List Names of Everyone in Household:

Signature of Adult Household Member: ____________________________________

Printed Name of Adult Signing Application: ________________________________

Social Security Number:
The course(s) I will be taking is (are): _________________________________________

________________________________________________________________________


Briefly describe why you would like to take this class /classes/:

________________________________________________________________________

Family income limits for student eligibility
Source: New Jersey Community Action Association, Inc., Published in the Federal Register Feb. 15, 2000

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Family size: 1 Person 2 Persons 3 Persons 4 Persons 5 Persons 6 Persons 7 Persons 8 Persons
$ limit 15, 447 20, 812 26, 117 31, 542 36, 907 42, 272 47, 637 53, 002