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PARENT/GUARDIAN 1 INFORMATION

If applicable, please fill-in the information for both parents. If applicant’s parents do not live together, list primary custodial parent (the parent who claims the child as their dependent on tax returns) as Parent/Guardian1.

Parent/Guardian First Name

[{viewVars.regValidation.firstName}]

Parent/Guardian Last Name

[{viewVars.regValidation.lastName}]

Street Address 1

[{viewVars.regValidation.address1}]

Street Address 2

[{viewVars.regValidation.address2}]

City

[{viewVars.regValidation.city}]

Postal Code

[{viewVars.regValidation.postalCode}]

Phone Number 1

[{viewVars.regValidation.phone}]

Phone Number 2

[{viewVars.regValidation.phone2}]

Email Address

[{viewVars.regValidation.email}]

Total Number of People in Household

[{viewVars.regValidation.people}]

Annual Household Income

[{viewVars.regValidation.income}]

Marital Status

[{viewVars.regValidation.maritialStatus}]

Did applicant or any family member utilize Youth Advantage's services in the past?

Yes

Please list first and last name(s) of scholarship recipient(s)

[{viewVars.regValidation.scholarshipRecipients}]

How did you learn about Youth Advantage?

[{viewVars.regValidation.source}]

Comments
If there are any extenuating financial difficulties that limit your ability to pay full tuition for your child this year and your child is not currently on a free or reduced-fee lunch program, please provide details on your circumstance and explain why this is a temporary situation.

PARENT/GUARDIAN 2 INFORMATION

Parent/Guardian 2 First Name

[{viewVars.regValidation.firstName2}]

Parent/Guardian 2 Last Name

[{viewVars.regValidation.lastName2}]

Parent/Guardian 2 Phone

[{viewVars.regValidation.phone3}]

Parent/Guardian 2 Email

[{viewVars.regValidation.email2}]