2025 Financial Statement

Thank you for participating in the Madeira Schools Foundation program. The below form will be used in applications for The Russell-Emery Scholarship, Adrick Family Scholarship, Achieve Your Potential Scholarship, Stephen M. Kramer Scholarship, The Firestone Scholarship and John D. Rahe Scholarship. You only need to fill this out once if you are applying for any or all of the above scholarships.

Personal information will be redacted during judging and all financial information will be deleted as soon as judging is completed.

Student Name *

First

Last

Phone *

Email *

Student Identification Number *

Personal Information will be redacted while judges are reviewing your application. This number will be used to track your application.

Financial Information Sheet For Parents/Guardians

To be filled in by parent or legal guardian and student. NOTE: This page will be shredded upon completion of scholarship process. Signatures are required of both the parent / guardian and the student.

To be completed by parent or legal guardian

Parent / Legal Guardian 1 *

First

Last

Parent / Legal Guardian 2

First

Last

Parent / Legal Guardian Phone *

Parent / Legal Guardian Email *

Size of Household (including applicant, parent(s), dependent children and other dependents):

Persons in family currently attending a post-secondary institution (college or vocational).

Does your family have any unusual circumstances? (financial or otherwise)

Please indicate if you will contribute financially to your student’s college education:

To be completed by student / applicant.

I estimate my expenses for the next year to be:

Tuition

Books

Transportation

Room & Board

Total Anticipated Expenses

Do you receive social security or funds from another source?

Do you have a savings, trust or 529 account?

Signature

I certify that the information given is true to the best of my knowledge.

Date

2025 Financial Statement

Financial Information Sheet For Parents/Guardians

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