Scholarship Application A limited number of scholarship dollars are available on a need basis. A.C.T. ~ For the Children Scholarship Application The class is $100. If you believe you have financial circumstances that would qualify you for free or reduced cost tuition, please complete the Financial Disclosure Affidavit, in support of Scholarship Application below. If you are being represented by Legal Aid, please do not complete a Scholarship Application.Which court is your case in? *Family Court of the State of New YorkSupreme Court of the State of New YorkCase Number *Petitioner / Plaintiff *Respondent / Defendant Title First Name *Last Name *Email *Phone *What is your annual income from all sources? *Employer Information *Please enter your employers name, address, and phone number. If you are self-employed or unemployed, please indicate that in this area.Weekly gross salary / wages *Interest / Dividend Income *Please enter amounts for any other sources of income. Workers Compensation Disability Benefits Unemployment Benefits Social Security Benefits Veterans Benefits Pensions and Retirement Benefits Fellowships / Stipends / Annuities Number of members in your household, including yourself, for whom you are financially responsible. *Supporting Documents *You are required to attach to this form a current and representative paycheck stub OR a copy of the W-2 Wage and tax statement(s) that was submitted with your most recent State and Federal Income Tax returns, OR pages 1 and 2 of the most recently filed Federal Income Tax return.Signature *By typing your name and submitting this form you confirm that all of the information provided is true. VerificationPlease enter any two digits *Example: 12This box is for spam protection - <strong>please leave it blank</strong>:
