Tuition assistance

Tuition Scholarship Application

Renewanation Virginia Scholarship Foundation family application, revised February 2024.

Protect your financial information: Complete and print this form, then provide the requested documents directly to the school through its approved process. Do not email tax returns or other financial records. Information entered on this page is not transmitted or stored.

Scholarship application form

Only children entering grades K–12 are eligible. One application per family is required.

Student and family information

Parent or guardian 1 name Parent or guardian 2 name Address City State ZIP code Home phone Work phone Cell phone Public school district in which the family resides

Children applying for scholarship

List every child applying for a scholarship
Child’s name	Date of birth	Relation to guardian	School attended last year	Grade level last year
Child 1 name	Child 1 date of birth	Child 1 relation	Child 1 previous school	Child 1 previous grade
Child 2 name	Child 2 date of birth	Child 2 relation	Child 2 previous school	Child 2 previous grade
Child 3 name	Child 3 date of birth	Child 3 relation	Child 3 previous school	Child 3 previous grade
Child 4 name	Child 4 date of birth	Child 4 relation	Child 4 previous school	Child 4 previous grade
Child 5 name	Child 5 date of birth	Child 5 relation	Child 5 previous school	Child 5 previous grade
Child 6 name	Child 6 date of birth	Child 6 relation	Child 6 previous school	Child 6 previous grade

Scholarship eligibility statements

An affirmative answer to every statement is required for scholarship eligibility.

I am a Virginia resident.
I certify that the above student(s) is/are entering grades K–12 in the Fall/Spring.
I certify that our family qualifies for the scholarship program according to the income guidelines.
I agree that my child(ren) may participate in testing to measure learning achievement and results will be reported to the RAN Virginia Scholarship Foundation.
I promise to ensure at least 90% attendance of my child(ren) or risk the loss of their scholarship.
I promise to pay my child’s school account in a timely and responsible manner.
I understand that failure to stay current with tuition & fee payments will result in loss of the RAN scholarship funds.

Is this a first-time application?

Reapplication year, if applicable

Financial information

All parents and guardians who claim scholarship recipients as dependents must report income and provide supporting documentation.

Head of household name Adults in household Children in household

Household income sources
Income source	Father	Mother	Other	Household total
Adjusted gross income reported on current Form 1040	Father adjusted gross income	Mother adjusted gross income	Other adjusted gross income	Adjusted gross household total
Other public assistance	Father public assistance	Mother public assistance	Other public assistance	Public assistance household total
Any other additional income	Father additional income	Mother additional income	Other additional income	Additional income household total
Total individual and household income	Father total income	Mother total income	Other total income	Total household income

Attach copies of last year’s Form 1040 and other supporting proof of income. Married couples filing separately must attach both forms. For a free copy of a Form 1040, call the Internal Revenue Service at 1-800-829-1040.

Certification and signatures

By signing below, I certify that all information provided on this application is true and complete to the best of my knowledge. I agree to provide proof that the statements made in this application are true, and I acknowledge that failure to do so will invalidate any possible scholarship. I further understand that all conditions must be met by my child and family to be eligible for a Virginia Scholarship Foundation award, and I agree to release Renewanation from liability in its efforts to provide this scholarship.

Parent or guardian 1 printed name Parent or guardian 1 signature Date Parent or guardian 2 printed name Parent or guardian 2 signature Date

Complete only if you do not file a Form 1040

Parents or guardians using a notary must also provide supporting financial information.

I certify that this applicant has provided me or this notary service with adequate proof of income and that, to my knowledge, the financial information provided on this form is true and complete.

Notary signature Date Notary name printed Space for notary stamp