2021 Tuition Assistance Application

Date Submitted
The completed form and 50% tuition must be submitted at the time of registration.

Students Name (required)

Students age(required)

Students Date of Birth

Address:
City
State
Zip
County of Residence
Phone: CellHome
Your Email (required)

Total cost of Tuition $
Current combined Gross annual household income: $ (required)

Please send Berkshire Pulse 2019 or most recent IRS Form 1040 with all attached schedules and
business IRS schedule C.

Both parents must submit 1040 if filed separately.

Include all sources of income, including but not limited to salary, tips, bonuses, maintenance and child support;

Parent/Guardian # 1
Name
Relationship
Street Address
City, State, Zip
Phone Cell
Employer/Postion Work Phone
Email Gross Annual Income

Please use your finger or mouse to sign in space below.

Signature

Parent/Guardian # 2

Name
Relationship
Street Address
City, State, Zip
Phone Cell
Employer/Postion Work Phone
Email Gross Annual Income

Please use your finger or mouse to sign in space below.
Signature

Date:

Please explain why you are applying for tuition assistance:

Please provide any additional information you think we should consider:

Tuition Assistance will be granted to students where combined annual gross household income is at or
below $50,000. For those not meeting this guideline, assistance will be equally considered if extenuating
circumstances apply. Payment plans are available.
Tuition Assistance is available for Community Class Pass only, not individual class payments.
All applications will be evaluated based on financial need.
Please note: Tuition assistance may not be used for the following:

• Performance Fees
• Late Registration Fees
• Fees for Private Lessons
• Payment of overdue tuition owed for prior sessions
• Dancewear or Merchandise
• Workshops
• Gift Certificates