As a divorced or single parent, complete the rest of the application as the applicant only. Do not enter information for the other parent/co-applicant. Insert N/A or 0 if not applicable. If the other parent needs tuition assistance, they must apply on their own, with a new application separately.

Additional Income - Applicant

Additional Income - Co-Applicant

I HEREBY AFFIRM THAT THE INFORMATION CONTAINED HEREIN AND ALL DOCUMENTS SUBMITTED HEREWITH ARE TRUE AND CORRECT. I AUTHORIZE THE COMMITTEE TO REQUEST CREDIT INFORMATION ABOUT THE UNDERSIGNED AND/OR TO OBTAIN COPIES OF THE UNDERSIGNED'S TAX RETURNS IN ORDER TO PROCESS OR VERIFY ANY INFORMATION CONTAINED HEREIN OR IN ANY OF THE DOCUMENTS SUBMITTED BY THE UNDERSIGNED IN CONNECTION WITH THIS APPLICATION. IN THE EVENT THAT ANY INFORMATION SUBMITTED HEREWITH IS INACCURATE, FALSE OR OTHERWISE MISLEADING, THE UNDERSIGNED HEREBY AGREES TO FORFEIT AND RETURN TO THE YESHIVA OF CENTRAL QUEENS ANY AND ALL MONEYS PROVIDED TO THE UNDERSIGNED AS FINANCIAL ASSISTANCE PURSUANT TO THIS APPLICATION AND FURTHER ACKNOWLEDGES THAT THE UNDERSIGNED SHALL BE PRECLUDED AND DISQUALIFIED FROM APPLYING FOR ANY FUTURE FINANCIAL ASSISTANCE. IN THE EVENT THAT COLLECTION OF THESE AMOUNTS FROM THE UNDERSIGNED BECOMES NECESSARY, THE UNDERSIGNED WILL ALSO BE RESPONSIBLE TO REIMBURSE THE YESHIVA OF CENTRAL QUEENS FOR ALL COSTS OF COLLECTION, INCLUDING COSTS OF INVESTIGATION AND REASONABLE ATTORNEY'S FEES. IN CASE MY FINANCIAL SITUATION IMPROVES I AGREE TO INFORM THE BUSINESS OFFICE AND MAKE APPROPRIATE ADJUSTMENTS IN MY TUITION PAYMENTS. SHOULD I HAVE THE RESOURCES IN THE FUTURE, I PLEDGE TO REIMBURSE YCQ FOR THE TUITION ASSISTANCE FUNDS AWARDED TO ME BY THE SCHOLARSHIP FUND IN ORDER TO ENABLE THE FUND TO ASSIST OTHERS IN NEED. BY SIGNING THE BOX YOU ARE CONFIRMING ALL THE INFORMATION ENTERED ON THIS DOCUMENT ARE CORRECT AND YOU AGREE WITH THE ABOVE INFORMATION.