Parent 1 Last Namerequired

Parent 1 First Namerequired

Parent 1 Emailrequired

Parent 2 Last Name

Parent 2 First Name

Parent 2 Email:

Home Phone:required

Addressrequired

Cityrequired

State:required

Zip Coderequired

Please provide information about all children in the family detailing age, grade, and school attending.

Number of children in the family*

2 3 4 5

Child 1 Last Namerequired

Child 1 First Namerequired

Child 1 Current Graderequired

Child 1: Which school does this child attend in 2021-22?required

Child 1: Which school will this child attend in 2022-23?required

Child 2 First Namerequired

Child 2 Last Namerequired

Child 2 Current Graderequired

Child 2: Which school does this child attend in 2021-22?required

Child 2: Which school will this child attend in 2022-23?required

Child 3 Last Namerequired

Child 3 First Namerequired

Child 3 Current Graderequired

Child 3: Which school does this child attend in 2021-22?required

Child 3: Which school will this child attend in 2022-23?required

Child 4 Last Namerequired

Child 4 First Namerequired

Child 4 Current Graderequired

Child 4: Which school does this child attend in 2021-22?required

Child 4: Which school will this child attend in 2022-23?required

Child 5 Last Namerequired

Child 5 First Namerequired

Child 5 Current Graderequired

Child 5: Which school does this child attend in 2021-22?required

Child 5: Which school will this child attend in 2022-23?required

Please provide the information below regarding your family income.

Total of Checking & Savings Account Balancesrequired

Total Other Investment Account Balancesrequired

Total UTMA & 529 Balances (all children)required

Total Retirement Savings (IRA, 401K, 403b, other)required

Total Value of all Other Assets (please itemize all assets with a value of $10,000 or more)required

Purchase Price of Homerequired

Current Value of Homerequired

Current Mortgage Balance (principal only)required

Outstanding Student Loans for Parents’ Higher Educationrequired

Please list your total AGI (Adjusted Gross Income) as reflected in submitted 2020 tax returnrequired

Expenses

Are there extraordinary expenses that you would like to be considered regarding your eligibility for this grant? Please list expense type and amount.

Tax return*

Please advise how you will submit your tax return

Upload here I will be sending my Tax return by mail. Please send return to Debra May at SAR, 655 West 254th Street, Riverdale, NY 10471

Tax Return

Max file size: 10 MB

Acknowledgement:

I/We hereby affirm that the provided information is correct and the tax return being submitted is our final 2020 return.

Parent Signaturerequired

Parent 2 Signature

Daterequired