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2023-2024 Buckeye Scholarship Application

Please complete the form below. Required fields marked with an asterisk *

Name*

Answer Required

Address*

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Email*

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Mobile Phone*

Number Required

Home Phone

Number Required

Approximately how long have you lived in St. Barnabas Parish?*

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How many of your children are/will be enrolled at St. Barnabas School? Please indicate grades.*

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Why are you applying for the Buckeye Scholarship?*

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Amount of scholarship award you are seeking:*

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Describe your active participation in parish/school activities:*

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Please attach a copy of your signed Federal income tax return (include all schedules) filed with the IRS in April, 2023 and provide the following additional financial information:*

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Choose a file or drag it here.

INCOME:

Adjusted gross income from your IRS form 1040:*

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Other non-taxable income/awards (i.e. child support, non-taxable social security, disability payments, etc.)

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MONTHLY EXPENSES:

Mortgage payment or rent*

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Real Estate taxes*

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Health Insurance premiums*

Answer Required

Car payment(s)*

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Utilities (gas, electric, phone)*

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Credit card debt*

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Contribution to St. Barnabas Parish*

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Personal loan*

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Home equity loan*

Answer Required

Total Other Catholic school tuition

Answer Required

Student, School, Tuition, Financial Assistance Award

Answer Required

Student, School, Tuition, Financial Assistance Award

Answer Required

Other significant expenses not listed above:*

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ASSETS:

Savings Account Balance(s)*

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Stocks, Bonds, Mutual Funds, etc (Market Value)*

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Certificate(s) of Deposit*

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Money Market Accounts/Funds*

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Life Insurance Policies (Cash Value)*

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Other Investments, i.e. IRA, 401K, etc.*

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Please direct all questions to Lisa Sarcinella at 773.445.7711 or [email protected]

I acknowledge that the information I have provided above is true and correct to the best of my knowledge.

Name and date*

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Confirmation Email

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