FINANCIAL NEED QUESTIONNAIRE

Guidance Counselor Feedback

To be completed as part of the Legence Bank Scholarship Application.

Question Title

* 1. Please confirm the student’s physical mailing address (no PO box):

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Question Title

* 2. If possible, can you please confirm the income bracket for the student's family?

$25,000 or less

$26,000 - $49,000

$50,000 - $74,000

$75,000 - $99,000

$100,000 or over

Question Title

* 3. Is the student receiving free or reduced lunch?

Yes

No

Question Title

* 4. Did the student apply for a Pell Grant?

Yes

No

Question Title

* 5. Did the student receive a Pell Grant?

Yes

No

Question Title

* 6. Are there other indicators you can share regarding this student’s financial need?