Griswold Family Association



GRISWOLD FAMILY ASSOCIATION Scholarship Application page 3

Part Il - Financial data to be completed by parent or guardian (if applicant is a dependent)

Please take the information from your completed 2019 IRS income tax return

Taxable Income:

Father ___________

Mother ___________

Applicant ____________

Number of dependents on parent's tax return ____________________(indicate if filing separately)

Applicant's parents' marital status is ___ married____ single___ divorced_______ widowed_______

Total of family members who will be attending post-secondary school at least half-time during 2020-21 school year (include applicant)


Part III - Certification and Signatures Certification:

All of the information on this form is true and complete to the best of my (our) know- ledge. If asked by an authorized official, I (we) agree to provide proof of the information I (we) have given on this form. I (we) also realize that if I (we) do not provide such proof if asked, the applicant may not receive scholarship aid.

Signatures: Applicant _________________ Parent/Guardian ___________________ Date ___________________