Ernest L. McKinney McKinney Scholarship Application

(Confidential for Director Only)

You will receive a confirmation email when your application is received.

The McKinney Center Director will email you once the application has been processed. Please include a valid email when filling out this application.

If your application is approved you will receive a promo code in your acceptance email. You will then visit www.mckinneycenter.com to register for the classes of your choice. You will enter the promo code during the checkout area of the registration form.

General Guidelines

Please read and type name below indicating that you understand and agree to comply with General Guidelines

Scholarship money is available for students that demonstrate a financial need. Scholarships will be provided based on family need demonstrated through both household size and income and in some cases by school principal and/or counselor recommendations.
Only ONE scholarship form is required per household.
Scholarships are awarded on a first come, first served basis.
The Ernest L. McKinney Scholarship has three semesters: Fall, Spring, and Summer.
Each child that is awarded a scholarship will have access to one course/workshop per semester.
Returning scholarship applicants must fill out new forms before each Fall semester.
Applicants should submit a completed application along with the required documentation on or before the registration deadline.
Only completed applications submitted before the stated deadline will be considered. Incomplete applications will not be eligible for consideration.
Once a decision has been made, the applicant will receive written notice as to whether or not scholarship money is available.
Scholarships will not be retroactive.
Partial scholarships may be awarded. If the student is awarded a partial scholarship, you will be asked to submit payment of the remaining balance by the last day of registration.
There are no refunds after the last day of registration.
Once the application has been processed a notification email will be sent to the email address provided. Those awarded a scholarship will receive a promo code. The student will register through www.mckinneycenter.com and will apply the promo code at check out.

Guardian to type name here to agree with General Guidelines

Date of Application

Guardian/Parent Name

1st Student Name

1st Student Date of Birth

1st Student School

1st Students Current School Grade

Do you have additional students applying for a scholarship

2nd Student Name

2nd Student Date of Birth

2nd Student School

2nd Students Current School Grade

Do you have additional students applying for a scholarship

3rd Student Name

3rd Student Date of Birth

3rd Student School

3rd Student Current School Grade

Parent/Guardian Name

Contact Phone Number

Alternate Phone Number

Email address

Mailing Address

Documentation Requirements

Proof of income includes a copy of current pay stub for all members of your household who get paid for working. Additional proof of income include: IRS 1099 Form, W-2 Form, letter from employer, Social Security statement, bank statement, court ordered awards letter, free/reduced school breakfast and food approval letter or letter from DSC or other foster care organization.

Upload your proof of free/reduced breakfast and lunch program

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Upload 2nd proof of income, if needed

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Upload 3rd proof of income, if needed

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If you are unemployed please check here

Name of Employer

Employer Address

Employer Phone Number

Rate of pay and how often

Include a brief statement containing your work hours

How many children live in your home? List all children and ages who live in the household

List all other adults living in your household. Write NA for adults not employed. If employed, list their employer and pay rate. Please provide proof of this income.

#1 Name living in household

#1 Employed with

#1 Rate of pay & How often

Proof of Income

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#2 Name living in household

#2 Employed with

#2 Rate of pay & How often

Proof of Income

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#3 Name living in household

#3 Employed with

#3 Rate of pay & How often

Proof of Income

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Do you need additional space to list people living in household?

Names of additional persons living in my household

List any additional income sources for yourself or any other adult in your household such as Alimony, Social Security Benefits, Food Stamps, SSI, HUD, water/energy assistance, etc. Write NA if there are no additional income sources.

Child Support

SSI Amount

Food Stamps

Alimony

Other

Is there any additional information you would like for us to know about your circumstances?

I understand that my employers may be called to verify monthly income. I understand if I have made any misrepresentation on this application I will be asked to return any scholarship money received. Scholarship applications are reviewed on a semester basis, and ARE NOT retroactive. I verify that all information on this form is an accurate representation of my family's annual income.

Checkbox*

By typing name you agree to ensure that the student will be at every class meeting and understand that missing class may result in loosing future scholarship opportunities.

Parent/Guardian Name

Student Name

Date

Check Here if you need to communicate with staff regarding any extenuating circumstances of financial strain that should be considered as part of this application, i.e. medical bills

By typing name below and submitting the application electronically, I certify that to the best of my knowledge and belief that all of the information contained is correct and complete. I understand if I have made any misrepresentation on this application I will be asked to return any scholarship money received.

Parent/Guardian Signature electronic

Date Field

If you have any questions you may email the Director at [email protected]

The McKinney Center is located at 103 Franklin Avenue, Jonesborough, Tennessee 37659

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