1. education
2. school

Who may apply
Thank you for your interest in Children’s Scholarship Fund- Charlotte (CSF-C). The mission of CSF-C is to open the doors of
educational opportunity for low-income families in Mecklenburg County by providing access to the independent schools of their
choice. CSF-C also offers funding for Homeschooled children. We do this by providing partial tuition assistance to families who
meet the following requirements:
● legal residents of Mecklenburg County
● children entering grades Kindergarten - 8th
● children entering Kindergarten or transferring from a public school or homeschool (they did not attend a private
school last year unless it was a pre-K program)
● families demonstrating financial need as measured by standards similar to the Federal Free and Reduced School
Lunch Program
How the scholarships are processed
All complete scholarship applications received are processed in a first-come, first-served order. Please reference all instructions
required for a complete application. WE ONLY ACCEPT COMPLETE APPLICATIONS that have all required signatures and all
required supporting documentation, including any additional information that may be requested after initial review. If you
submit an incomplete application it will not be processed. Due to the high volume of applications received we do not provide
“status checks” on applications.
How to submit an application
We DO NOT accept applications by fax. You may submit your application by mail or bring it to Foundation For The Carolinas at
220 North Tryon, Charlotte, NC 28202 and leave it with the receptionist in the front lobby. If you bring in your application, please
be advised that we will not be available to meet you to discuss your application due to the time constraints during application
cycles. If you have questions please submit them by email for the most expedient reply. Upon review of your application,
additional information may be requested. Your prompt reply will be needed to avoid delay in processing your application.
Resources
If you are interested in finding a school list or have questions regarding Homeschooling, please visit the North Carolina
Department of Administration Division of Nonpublic Education web site at www.ncdnpe.org.
Thank you for your interest in CSF-C and we wish you success!
For Your Information Only
NOTE: DO NOT RETURN THESE FORMS TO CSF
2014-2015 Income Eligibility Scale
*Maximum Income Based on Total Annual 2013 Income
House size
Maximum Eligible Income*
Two
$41,877
Three
$52,731
Four
$63,585
Five
$74,439
Six
$85,293
Seven
$96,147
Eight
$107,001
For Each Additional Family Member
Add $10,854
Note: Please note the scholarship amounts vary depending on the family’s income, household size and the
school’s tuition cost. The highest scholarship amount for independent schools for 2014-15 will be $2,500 per
child. Families will be required to contribute partial tuition ($500 minimum per family) towards their child’s
education.
The highest scholarship amount for Homeschoolers is $500 per child (and the $500 minimum requirement
does not apply). For additional information about our scholarship guidelines and program eligibility
requirements, please visit our website:
Failure to complete any of the steps for the application will delay or deny the processing of
your application.
Helpful Application Checklist
NOTE: DO NOT RETURN THESE FORMS TO CSF
Please make sure you have done the following to submit a COMPLETE application for processing:
□ I filled in all blank spaces that is required information asked for on the application forms and I SIGNED and dated all forms
where indicated
□ The number of household members on my application form agrees with the number of dependents on my 1040 Federal Income
Tax Return
□ I provided legible documentation verifying all my household income sources, including:
□ 2013 Federal Tax Return signed on page 2, and the tax return of the person claiming my child as their dependent if
other than myself
□ Section 8 Housing Assistance or other Public Assistance- I provided all benefit statements for January through
December 2013, including the statement listing the names of persons in my household
□ Food Stamps/ SNAP/EBT- I provided all the benefit statements for January through December 2013, or I requested a
printout from the agency reflecting the same, including the page listing the names of persons in my household
□ Child Support and Alimony- I provided a legible and unaltered copy of the official court-ordered support, or deposit
statements, or other notarized documents showing payments received for January through December 2013
□ Social Security/SSI/Disability benefits- I provided legible and unaltered copies of official benefit statements or letters
for all family members in my household who received benefits from January through December 2013
□ Unemployment benefits- I provided legible and unaltered copies of official statements including the benefit periods
and the amounts received in 2013
□ Worker’s Compensation- I provided legible and unaltered copies of official statements including the periods and the
amounts received in 2013
□ Other government assistance- I provided legible and unaltered copies of official statements including the benefit
periods and the amounts received in 2013
□ Financial assistance from family or friends, etc. - I provided a notarized statement or document indicating the periods
and amounts I received in 2013
□ If I did not file taxes, then my application has been notarized where indicated, and I have provided all income verification as
required
□ I made copies of my application pages and income documents to keep for myself
□ Where a known issue exists, such as a change in employment or income or household size since 2013, please provide a short
letter of explanation with your application so we can further discuss your individual situation if necessary.
□ You will be notified if any addition information is needed for your individual circumstance. If you do not have all of the
documentation required to complete your application, your application cannot be processed.
□ All scholarship recipients will receive an annual survey to be completed by its stated deadline. This survey is mandatory for all
scholarship recipient families, and scholarship awards are subject to be placed on HOLD or denied/terminated for failure to
complete and return this mandatory document. Agreement to complete this survey and any other program requirements is part
of the Terms of Agreement for your participation in our program.
Additional Information For
Homeschoolers Only
□ I included a completed W-9 with my application
□ I included a copy of my NC State Registration for my Homeschool (“Intent to
Operate a Homeschool”) or other official document that shows my
Homeschool is legally registered and operating in the state
Documentation Requirements: Please read through the Instructions carefully.
Household defined-A “household” includes all persons living at the
same address and/or all persons for whom the
head of household claims financial responsibility;
all persons for whom the recipient’s resident
guardian claims financial responsibility; and all
persons claiming financial responsibility for
scholarship recipients, even if the recipients do
not reside with him or her, along with all other
persons for whom that person claims financial
responsibility.

If a child is not claimed on your 1040 tax forms or budget letter, you
must provide proof of guardianship (i.e. court papers) and the 1040
tax forms or budget letter from the person claiming the child.
 You must list all sources of income. You must report the TOTAL
YEARLY AMOUNT and document all income! If you and your
spouse filed taxes jointly, you may list the total amount. Include the
income of others that provide support or have claimed the child/ren
as dependents.
Explanation of Income Sources*:
Adjusted Gross Income – Found on line 37 (1040) or line 21 (1040A). The 1040 tax forms are found in the package that was given to the
individual by the tax preparer. Any child/ren who are not claimed by the parent applying must send in the income information of the
parent/guardian who claimed the child/ren. PLEASE MAKE SURE THE SECOND PAGE OF THE 1040 IS SIGNED. Include only the
first two pages of the 1040. If the parent/guardian DOES NOT have a 1040, contact the Internal Revenue Service at 1-800-908-9946 and
request a transcript.
Child Support & Alimony Income – Provide official court ordered documents citing the amount being received. If child support is not court
ordered, a notarized document written by the person providing the support is required. The letter should include the total amount given to
the parent and must specify if given yearly, weekly, or monthly.
Public Assistance Cash & Food Stamp Income – This is found on a budget letter or notice of food stamp benefit you receive. A budget
letter is a printout obtained at the public assistance office showing the cash amount and/or EBT benefit the individual is receiving. To obtain
a copy of the amount of benefits received for 2013 please contact your assigned food stamp office and request a statement of benefits
received for January through December 2013. They will not fax the information to you.
Social Security Income – Provide official SSA-1099/SSI letters for all family members receiving SSA Benefits, SSI, and/or Disability.
Unemployment & Worker’s Compensation Income – Unemployment compensation is includible in gross income. You must report
unemployment compensation on line 19 of Form 1040, line 13 of Form 1040A, or line 3 of Form 1040EZ. If you do not claim your award on
your taxes, you are required to submit the 1099G form (award letter).
Other Income – If you do not file taxes, but work, you must provide a notarized letter from your employer stating your total annual income.
If you are receiving assistance from family/friends, you must provide notarized letters written by the person providing the support. The letter
must state the annual amount given to you. If you are a FOSTER parent, an official letter from the Aid to Families with Dependent ChildrenFoster Care Program (AFDC-FC) must be submitted. No applicant can claim “0” (zero) income on the application.
If you did not file taxes, you must get the income declaration form notarized!
Please sign your name and date the page to certify all information is accurate. All income documentation is still required.
School Commitment Form: This form is included in the application packet. Please have the school administrator at the school your child
will attend complete this form. Complete one form per child. The tuition information must be provided by the school. Please remind the
school to send us a copy of their tuition schedule when they return the form to us. This form is due with your application. Notify CSF-C if
this form cannot be completed by the deadline.
A “complete application” includes the School Commitment Form. This form will be completed by the school upon your child’s
enrollment at the school. Some flexibility will be allowed- for a period of time- if you have not yet selected a school. However, your
scholarship award will not be calculable or held until this determination has been made. Other completed applications will continue to
be processed, and your award cannot be guaranteed until your child is enrolled and we receive this form, provided funds remain
available.
If you are a Homeschooler please download the Homeschool Commitment Form in your packet. This form must be notarized, and
appropriate documentation of state law compliance must be attached (a copy of NC state homeschool registration or ‘Intent to Operate
Homeschool” that you filed with the state of NC upon registering your Homeschool). IRS Form W-9 is required of the administrator of the
Homeschool.
*All income sources and benefit statements required are to be from 2013 (January – December). Current information will be
requested on a case by case basis. You may advise us if your financial situation has changed since 2013.
Send Completed Forms To:
Children’s Scholarship Fund-C
220 North Tryon St.
Charlotte, NC 28202
Questions? Email
[email protected] or visit
www.csfcharlotte.org
*** This form does not guarantee a scholarship.
Registration Application 2014
APPLICATION DEADLINE: May 30, 2014
PARENT/GUARDIAN INFORMATION: Complete for each parent in your home*
Marital Status (check one):
Last Name:
First Name:
Middle Initial:
□Single □Married □Divorced
□Separated
Mailing Address:
City:
Home Phone:
Apartment Number:
State:
Zip:
Work Phone:
County:
E-mail Address:
Cell Phone:
Relationship to child/ren (check one): Note: A copy of official custody
documents must be on file for all designations other than “Mother” or “Father” or
“Stepparent”
□Father □Mother □Stepparent □Grandparent □Foster parent □Guardian
PARENT/GUARDIAN INFORMATION*
Last Name:
First Name:
Home Phone:
*The first parent listed on this form will be
our primary contact and the person who
will be required to sign most documents
related to the CSF-C program.
Middle Initial:
Mailing Address:
City:
Alternate Phone:
Marital Status (check one):
□Single □Married □Divorced
□Separated
Apartment Number:
State:
Zip:
Work Phone:
County:
E-mail Address:
Cell Phone:
Relationship to child/ren (check one): Note: A copy of official custody
documents must be on file for all designations other than “Mother” or “Father” or
“Stepparent”
□Father □Mother □Stepparent □Grandparent □Foster parent □Guardian
Alternate Phone:
*The first parent listed on this form will be
our primary contact and the person who
will be required to sign most documents
related to the CSF-C program.
STUDENT INFORMATION
List any student who is declining the scholarship for any reason, or who is returning to public school in 2014-15. Provide the reason
for declining the scholarship:
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
Please list below all children who are Requalifying students and are currently in the CSF-C program. Only children entering grades K-8
are eligible.
DO NOT add new siblings here. Please contact our office to obtain a Sibling Form if you wish to add additional eligible children.
First and last name
School attended last year
(2013-14)
School attending 2014-15
Grade level in 2014-15
Child 1
Child 2
Child 3
Child 4
VERIFICATION
Conditions of Eligibility:
By initialing these boxes, I understand the following conditions must be met in order to maintain a CSF-C scholarship:
I promise to pay my child’s school account in a timely manner.
I will ensure at least 90% school attendance of my child(ren), and comply with the policies and procedures and standards of my child(ren)’s
chosen school.
I understand that it is the responsibility of the parent/guardian to resolve issues (i.e., payments, tuition costs, disputes over balances and fees
owed to the school) according to the school’s policies and procedures.
I understand that students receiving this CSF-C scholarship must continue to be a legal resident of the program area (Mecklenburg County).
The students receiving this CSF-C scholarship must be enrolled as a student between kindergarten and 8th grade for fall 2014.
I understand that the student receiving this CSF-C scholarship must attend the chosen school for 3 weeks before the CSF-C scholarship
payment will be made. I also understand that transferring the CSF-C scholarship recipient after 3 weeks of enrollment may result in a
prorated CSF-C scholarship award.
I will immediately inform CSF-C of any changes or conditions that could affect our scholarship award or eligibility or the CSF-C program
administration. This includes, but is not limited to: my child withdrawing from or transferring schools; any financial aid awards granted by my
child’s school or changes in tuition; any changes in my address, phone number, or email; significant changes in my household income or job
loss, etc.
Parental/Guardian Agreement to Provide Information CSF is interested in maintaining historical data on CSF scholarship recipients in
order to evaluate the impact of the program. By initialing this box, I understand if awarded a CSF scholarship, I agree to provide Children’s
Scholarship Fund Staff the following:
 Reasons for withdrawing the CSF scholarship recipient(s) from private school, Christian school or homeschool
 Yearly updates on the status of the CSF scholarship recipient(s) upon completion of the 8th grade
 Final update on the status of the CSF scholarship recipient(s) upon completion of high school
I understand that failure to comply with the above statements will result in the loss of my family’s scholarship. I certify that all the information
provided on this form is true and complete to the best of my knowledge
I will ensure that I complete and return the annual Parent/ Student Surveys, and all other required program documentation, by their stated
deadlines.
VERIFICATION
Parental/Guardian Agreement to Provide Information: CSF-C is interested in maintaining historical data on CSF-C scholarship
recipients in order to evaluate the impact of the program. I understand if awarded a CSF-C scholarship, I agree to provide CSF-C staff
the following: I agree to allow the school to release grades and standardized test scores for use by Children’s Scholarship Fund “CSF”, in order to
allow CSF to evaluate this program. I agree to allow my child’s picture to be taken and used for promotional and fundraising purposes. Finally, I
agree to release CSF from any and all liability in its efforts to provide this scholarship.
Date
Signature of Applicant
SIGN HERE
DO NOT WRITE HERE, FOR CSF USE ONLY:
DATE RECEIVED COMPLETE:
AWARD%: _________
RETURNED TO SENDER ON: __________________
SCHOOL:
Parent/Guardian’s Name:
First Name
Last Name
Middle Initial or Name
Registration Application 2014
All parents or guardians must claim children as dependents and must report their 2013 annual income on this form and attach
supporting documentation of that income. Enter all household income information in the table below as annual amounts for 2013.
Total number of people in household: Adults _________ Children _________
INCOME SOURCE
FATHER
MOTHER
OTHER
Adjusted Gross Income reported
on 2013 FEDERAL 1040*
Social Security Benefits
AFDC/ADC
Food Stamps, EBT, SNAP
Child Support in 2013
Unemployment (List only if not filed on
2013 tax return)
Section 8/Other Public Assistance
Any other additional income
received in 2013
Total Household Income
(Sum of bottom row)
TOTAL Individual Income
* Please attach a copy of your 2013 Federal 1040 Tax Return with dependents listed and proof of all income from 2013.
Married couples filing separately must attach both forms. Failure to document income by the deadline may result in the
loss of your scholarship. DO NOT SEND STATE TAX FORMS. For a free copy of your 1040 call the Internal Revenue
Service at 1-800-829-1040.
Complete this section only if you did not file taxes for 2013
Parents and guardians using a notary must also provide official documentation of all 2013 income, such as public assistance statements,
child support documents, and Social Security statements.
Space for Notary Stamp
Notary signature _____________________________________ Date ____________________________
Notary name _______________________________________ Date ____________________________
I certify that all the information provided on this form is true and complete to the best of my knowledge & I agree to release CSF from any liability in its efforts to
provide this scholarship.
SIGN HERE
_________________________________________________________________________________________________________________
Signature of Parent or Guardian
Date
SIGN HERE
_________________________________________________________________________________________________________________
Signature of Parent or Guardian
Date
Send Completed Forms To:
Children’s Scholarship Fund-C
220 North Tryon St.
Charlotte, NC 28202
Questions? Contact
[email protected]
School Commitment Form 2014
Homeschoolers
This Form MUST be received with your application
Family Information:
Parent/Guardian who will be primarily responsible for home schooling: ______________________________________
SECTION 1
Address: ________________________________ Apt #________ City:_________ State:_________ Zip:___________
Phone: home(______)_______________ cell(_______)________________ work(_______)________________
Student Information:
Child’s Name
Attach a separate sheet of paper if necessary.
Age
Grade Level
Curriculum name or brief description
(Approximate)
SECTION 2
Please check the appropriate box for each statement below.
I have complied with all state regulations in order to legally educate these children at home.
(Appropriate documentation of state law compliance must be included.)
The children listed above are not enrolled in a public or private day school.
I have selected and/or planned a curriculum for these children for this academic year.
I promise to inform the scholarship program immediately if any of these children enroll in a
public or private day school, or discontinue schooling at home for any other reason.
□True □False
□True □False
□True □False
□True □False
TERMS OF AGREEMENT
I have chosen to educate the children listed above primarily at home. I have researched and complied with all state regulations
regarding compulsory attendance and home schooling. I have selected and/or planned a curriculum of study for this academic year.
I understand that the Children’s Scholarship Fund only reimburses approved costs as described in the CSF Home School
Guidelines. I acknowledge that the Children’s Scholarship Fund’s continued payment is strictly contingent upon our family meeting
and maintaining conditions of eligibility, and upon the submission of valid receipts for all allowed expenses. I agree to inform the
program immediately if conditions of eligibility should change or one of these children is no longer being educated primarily at home.
Finally, I certify the above information to be correct and agree to the terms outlined.
___________________________________________
Signature of Parent or Guardian
___________________________________________
Print Name of Parent or Guardian
____________________________
Relationship (e.g. “mother”)
__________________
Date
SECTION 3
3rd-Party Verification: Form must be notarized and proof of legal compliance attached.
I certify that the person named as “parent or guardian” above has read and understood the TERMS OF AGREEMENT, and has
signed this document in my presence as certification that it is true and complete.
Space for notary stamp
______________________________________________________
Notary Signature
______________________________________________________
Notary Name, Printed
_________________
Date
Do Not Return This Page
All applications must have the following minimum requirements :
Final Checklist:
3- page application, completed and signed on pages 2 and 3. Do not leave any fields blank– enter “N/A” if
not applicable.
Page 1 and 2 of your 2013 Federal Income Tax Return, signed on page 2. Even if you filed electronically
still sign the signature line– both parties must sign joint returns.
School Commitment Form
About the School Commitment Form (SCF): This form is considered part of a complete application
and no scholarship award will be granted without it. It is to be given to the school administrator for
completion upon your child’s registration at the school. Applicants are not to complete this form. If
you have not registered your child in the school at the time of your application, you will NOT be
guaranteed a scholarship award. Applications can only be processed for possible eligibility without
the SCF. Once the SCF is completed and submitted, your scholarship award may be granted provided
funding is still available.
This is the minimum requirement for families who receive NO additional financial support or
assistance. If you or anyone in your household receives any type of benefits or assistance, then see all
accompany instructions for submitting those required documents.
Any application missing this minimum information cannot be processed.
Remember, late applications will be added to the first-come, first-served list and are not guaranteed to be
processed.