Form

Please fill out the following form to apply for a scholarship. One form may be filled out per household for up to 3 children. You will be notified of your application results within 60 days of submitting your application.

Scholarships are available to San Diego Chaldean & Assyrian youth ages 4-17! These programs range from $250 - $1,000 in value. Thank you!

Parent Information

Today's Date

Month-Day-Year

Parent First Name*

Parent Last Name*

Relation to Child*

Mother

Father

Guardian

Other:

Phone number*

Email*

Language Preference

Child Information

First Name

Last Name

Date of Birth*

Gender*

Child #2 Information (Optional - skip if necessary)

First Name

Last Name

Date of Birth

Month-Day-Year

Gender

Child #3 Information (Optional - skip if necessary)

First Name

Last Name

Date of Birth

Month-Day-Year

Gender

Household Information

Total Household Income (Monthly - $)*

Number of Children in Your Household During the Last Tax Year*

Number of People in Your Household, Total*

Document Upload

Please provide a picture or copy of your Tax Form 1040, or Medical Card, or Adult Food Stamp Card, or any other item that may prove income or that you receive government assistance.

This is a secure and private way to provide your documents and will not be shared with anyone outside of the Ayana Group’s scholarship review committee.

Upload Document/Choose File*

Note: No guarantee of assistance is implied by this application. A copy of your IRS form 1040 from the recent tax year may be requested to secure scholarships. The scholarship that will granted to students will ultimately depend on the decision of the scholarship review committee.