GMA Financial Assistance

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* 1. Complete the following

Parent's Name

Child's Name 1

Child's Name 2

Home Address

Phone Number

Child's School

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* 2. Documentation of Financial Need:

	Yes	No
My child receives free or reduced lunch at school.	My child receives free or reduced lunch at school. Yes	My child receives free or reduced lunch at school. No
My family qualifies for state or federal assistance.	My family qualifies for state or federal assistance. Yes	My family qualifies for state or federal assistance. No

Other (please specify)

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* 3. What is highest level of education for each parent?

	Elementary	Some high school	GED or High School graduate	Some college	College Degree	Post-graduate degree
Mother	Mother Elementary	Mother Some high school	Mother GED or High School graduate	Mother Some college	Mother College Degree	Mother Post-graduate degree
Father	Father Elementary	Father Some high school	Father GED or High School graduate	Father Some college	Father College Degree	Father Post-graduate degree

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* 4. Please describe financial, social, educational or other barriers that contribute to your need for financial assistance (i.e., single parent household, caregiver for elderly parent or family member, full time college student status, etc.). Please limit your respond to 200 words or less.