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IlluminXation Financial Aid Form
This information is confidential and will be used for the purpose of tuition assistance, if qualified. * Please fill out combined household income and expense.
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Email
*
Your email
DATE
*
MM
/
DD
/
YYYY
ILLUMINXATION PROGRAM
*
Cancer Smancer Reimagined Summer Program
Year Round Tutoring Program
REGION (country)
*
Choose
USA
Barbados
Jamaica
Trinidad
Other
PARENT/GUARDIAN NAME (First, Last)
*
Your answer
STUDENT NAME (First, Last)
*
Your answer
HOUSEHOLD WAGES (W2 INCOME)
Your answer
SELF EMPLOYMENT (1099 INCOME)
Your answer
COMMISSION INCOME
Your answer
OVERTIME
Your answer
BONUS
Your answer
NET RENTAL INCOME
Your answer
SOCIAL SECURITY INCOME (SSI)
Your answer
PENSION
Your answer
ALIMONY
Your answer
CHILD SUPPORT
Your answer
2ND JOB
Your answer
OTHER
Your answer
RENT/MORTGAGE EXPENSE
*
Your answer
UTILITY EXPENSES (GAS/ELECTRIC/WATER)
Your answer
CABLE/INTERNET EXPENSES
Your answer
CAR PAYMENTS
Your answer
CREDIT CARD PAYMENTS
Your answer
STUDENT LOANS
Your answer
OTHER EXPENSES
Your answer
A copy of your responses will be emailed to the address you provided.
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