SCI-Arc Admissions Office 960 East 3rd Street Los Angeles, CA 90013

Financial Statement & Scholarship Application

1. Applicant ___________________________________________________________________________________ Legal Name / Last First Middle Initial ___________________________________________________________________________________ Address City State Zip Country (if other than U.S.) ___________________________________________________________________________________ Email address Phone Number 2. Mother / Stepmother / Female Guardian ___________________________________________________________________________________ Legal Name / Last First Middle Initial ___________________________________________________________________________________ Address City State Zip Country (if other than U.S.) ___________________________________________________________________________________ Email address Phone Number 3. Father / Stepfather / Male Guardian ___________________________________________________________________________________ Legal Name / Last First Middle Initial ___________________________________________________________________________________ Address City State Zip Country (if other than U.S.) ___________________________________________________________________________________ Email address Phone Number 4. Child lives with: (check one below) ____ Mother & Father ____ Mother Only ____ Father Only ____ Other (please specify below) 5. Education Expenses Please list below all family members who will be enrolled in school or college (for upcoming school year)

Name of Student Age Relationship to applicant

School Education Expense borne by parent

DID Financial Statement & Scholarship Application, page 2 6. Asset Information For Homeowners Only: Year home purchased: Purchase price: Unpaid Mortgage: Total in savings accounts: Total in checking accounts: Real estate investments: $ $ worth debt Other investments: $ $ worth debt (For Business Owners Only) Business: $ $ worth debt

7. Divorced or Separated Parents (For parents who are receiving alimony and/or child support): Total amount of child support expected for all children this year: $ Total amount of alimony expected this year: $ Who claims child(ren) as dependent(s)? Name: 8. Special Circumstances Use this area to describe any special circumstances which affect your ability to pay the enrollment fee and which you believe should be considered. 9. Certification: I certify that answers given herein are true and correct to the best of my knowledge. I (We) agree to give proof of the information that I (we) have given on this form. I (We) realize that this form must be accompanied by my (our) most recent Income Tax Forms. Parent/Guardian printed name Parent/Guardian Signature Date