MBK Financial Aid Application

Hindi classes offered by MBK are for everyone. If you would like to be considered for reduced fee or no fee class, please complete this application.

Student Name: __________________________ SS# _______________

Date of Birth: _________________

Class/Location interested in: ______________________

Father's Name: ___________________________  SS# _____________

Place of employment ___________________ Income/yr _____________

Mother's Name: __________________________  SS# _____________

Place of employment ______________________ Income/yr __________

Other sources of Income/Year ________________

Last year's Family income __________________ (Attach a copy of last year's tax return)

Acknowledgement-Each of the undersigned hereby acknowledges that any owner of Madhu Bhasha Kendra, its services, successors and assignees, may verify any information contained in this application or obtain any information or data for any legitimate business purpose through any source including consumer reporting agency.

I/We understand that it is a Federal crime punishable by fine or imprisonment, or both to knowingly make any false statements concerning any of the above facts.

Parent Signature______________________________              Date _________

Parent signature ______________________________             Date________

Statement (Why do you feel you should be approved for financial aid?) ____________________________________________________________

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