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: