PCC Assistance Application

1 Start 2 Complete

Phoenix Children's Chorus Assistance Application

Please fill out all information to apply for financial assistance

Email Address *

Total number of adults and children living in household *

Part 1: List names of all children in household

Child 1

Child's Name *

School Name *

Grade *

PCC Choir Placement *

Child 2

Child's Name

School Name

Grade

PCC Choir Placement

Child 3

Child's Name

School Name

Grade

PCC Choir Placement

Child 4

Child's Name

School Name

Grade

PCC Choir Placement

Child 5

Child's Name

School Name

Grade

PCC Choir Placement

Additional Children unable to be listed above:

Please list with semi colon and space between each additional child being sure to include ages for each child.

Part 2: Name of adults in household and employer name

Adult 1

Adult Name *

Employer Name *

Adult 2

Adult Name

Employer Name

Please list with semi colon and space between each additional adult being sure to include occupation for each adult.

Part 3: Total Household Gross Income - You must tell us what you receive monthly

Income 1

Name *

Gross income monthly *

Earnings from work before deductions *

Welfare, child support, and/or alimony received monthly *

Pensions, retirement, and/or Social Security received monthly *

All other income *

Check if NO income

None

Income 2

Name

Gross income monthly

Earnings from work before deductions

Welfare, child support, and/or alimony received monthly

Pensions, retirement, and/or Social Security received monthly

All other income

Check if NO income

None

Income 3

Name

Gross income monthly

Earnings from work before deductions

Welfare, child support, and/or alimony received monthly

Pensions, retirement, and/or Social Security received monthly

All other income

Check if NO income

None

Income 4

Name

Gross income monthly

Earnings from work before deductions

Welfare, child support, and/or alimony received monthly

Pensions, retirement, and/or Social Security received monthly

All other income

Check if NO income

None

Income 5

Name

Gross income monthly

Earnings from work before deductions

Welfare, child support, and/or alimony received monthly

Pensions, retirement, and/or Social Security received monthly

All other income

Check if NO income

None

I certify (promise) that all information on this application is true and that all income is reported.

Parent/Guardian Name *

Address *

City *

State *

Phone Number *

Are you a New PCC Family or a Returning PCC Family? *

Special circumstances to request financial assistance:

Please send an email to [email protected] with the most recent paystubs of all adults working within the household. The paystubs should represent the total income within the household. The assistance application cannot be processed without this information so it is imperative you send the required documentation ASAP. Thank you!

I understand I must send the above mentioned documentation for my assistance application to be processed:
yes