Tuition in full, less any awarded scholarship amount, will be due upon acceptance to the program. If Mock Trial Academy does not receive this tuition payment within 14 days of the date of the student's acceptance letter, the student forfeits his/her scholarship package.

Please complete all fields.

Applicant Information
Full Name (First/Middle Initial/Last):

Parent/Guardian Information
Please fill out parent/guardian information for each parent or guardian (including step-parents if applicable). If your parents live together and you have no additional step-parents or guardians, complete only one section of information for both parents.

Parent/Guardian Name (First/Middle Initial/Last):

Relationship to Applicant:

Street Address:

City:

State:

Zip Code:

Area Code/Phone:		E-mail:
Occupation:		Annual Gross Household Income:

Number of dependents in the household:

Number of dependents in college and/or graduate school:

Parent/Guardian Name (First/Middle Initial/Last):

Relationship to Applicant:

Street Address:

City:

State:

Zip Code:

Area Code/Phone:		E-mail:
Occupation:		Annual Gross Household Income:

Number of dependents in the household:

Number of dependents in college and/or graduate school:

Parent/Guardian Name (First/Middle Initial/Last):

Relationship to Applicant:

Street Address:

City:

State:

Zip Code:

Area Code/Phone:		E-mail:
Occupation:		Annual Gross Household Income:

Number of dependents in the household:

Number of dependents in college and/or graduate school:

Parent/Guardian Name (First/Middle Initial/Last):

Relationship to Applicant:

Street Address:

City:

State:

Zip Code:

Area Code/Phone:		E-mail:
Occupation:		Annual Gross Household Income:

Number of dependents in the household:

Number of dependents in college and/or graduate school:

Other Circumstances
If there are other circumstances that you feel affect your need for scholarship, please state them below.

Requisite Documentation
All scholarship applicants must either mail or fax a copy of the 2009 Federal Form 1040 Income Tax Return for each applicable household. Applicants failing to do so will not be considered for scholarship assistance. Send this material to:
Mock Trial Academy, LLC
559 W. Diversey Pkwy. #123
Chicago, IL 60614
fax: 773.275.6401

Submitting Application
Please submit all pages of this application prior to the April 15, 2010 deadline by fax or mail as detailed in the Enrollment Application. In addition to this Scholarship Application, students must fill out and submit a 2010 Enrollment Application. When doing so, students need not send in the $250 Tuition Deposit that is typically required with an Enrollment Application.

Signatures and Authorization
The undersigned Parent/Guardian and Student swear and affirm that all statements made herein and documents attached are true and correct. Parent/Guardian and Student understand that this application is subject to the terms and conditions of Mock Trial Academy as set forth in the Enrollment Application.

Submitting Application
By submitting this application, I attest that I have read and agree to the terms stated above.