P.O. Box 4998 - 400 South Elm Street
South Street Plaza off I-391 - Holyoke, MA 01041
Telephone (413) 532-0465 - Fax (413) 532-2278
www.holyokeCAC.org
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Holyoke Creative Arts Center P.O. Box 4998 - 400 South Elm Street South Street Plaza off I-391 - Holyoke, MA 01041 Telephone (413) 532-0465 - Fax (413) 532-2278 www.holyokeCAC.org |
To find out if you qualify for a scholarship, please Print this page, fill in the information and mail, fax or bring it to the Center
A. Persons in your Household (including yourself) _________
B. For the line corresponding to your family size above, please check if your Household Income falls below this level. (If not, leave blank)
Family Size
| 1 person | 5 persons |
| $10,950______ $18,250______ |
$20,160______ $29,200______ |
$16,900______ $28,150______ |
$31,080______ $45,000______ |
| 2 persons | 6 persons |
| $12,500______ $20,850______ |
$23,040______ $33,350______ |
$18,150______ $30,200______ |
$33,420______ $48,350______ |
| 3 persons | 7 persons |
| $14,050______ $23,450______ |
$25,920______ $37,500______ |
$19,400______ $32,300______ |
$35,700______ $51,700______ |
| 4 persons | 8 persons |
| $15,650______ $26,050______ |
$28,800______ $41,700______ |
$20,650______ $34,400______ |
$38,040______ $55,000______ |
CLASS ___________________ DAY______ TIME_________ SESSION_________
Please print:
NAME________________________________ TEL. NO._____________________
ADDRESS___________________________________________________________
ETHNIC BACKGROUND______________________________________________
DATE______________ SIGNATURE______________________________________
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