Power2Parent EmpowerED Choice Scholarship Application
2025-2026 Academic Year

Income Eligibility Guidelines
The EmpowerED Choice Scholarship is designed to support low-income students by providing financial assistance for private High School tuition. To qualify, your household income must not exceed 300% of the Federal Poverty Level (FPL), as outlined in the chart below.

We encourage all eligible families to apply.

Before proceeding with your application, please review the income eligibility chart to determine your qualification.

SECTION 1: Student Information

Full Name

Date of Birth

High School Grade Level

School Address

School Attending

Section 2: Parent/Guardian Information

Primary Guardian Full Name *

Relationship to Student *

Email *

Phone Number *

Home Address *

County/District *

Secondary Guardian Full Name (if applicable)

Relationship to Student *

Email *

Phone Number *

Home Address (if different) *

SECTION 3: Household Information

Number of People in Household (2023-2024) *

Language(s) Spoken in Home *

Primary Guardian’s Current Marital Status *

Does either parent/guardian have a divorce agreement? *

Yes

Others Living in Household

Name | Age | Relationship to Guardian | How long has this person lived with Primary Guardian?

Section 4: Financial Information

A. Taxable Income (Upload 1040 Forms)

1040 Forms Upload Below

Total Annual Household Income (Line 9, 1040)

Net Business Income (Schedule 1, Lines 3, 5, 6)

Number of Dependents

B. Non-Taxable Income and Assistance

Child Support Received

Social Security Income

Other Non-Taxable Income (specify)

Total Non-Taxable Income

C. Housing and Monthly Expenses

Do you own or rent?

Own

Rent

Monthly Housing Expense

D. Unusual Circumstances

If you’ve qualified for an opportunity scholarship and lost funding due to legislative changes, please explain:

SECTION 5: Required Documentation

2023 Tax Return (Form 1040, signed)
Proof of non-taxable income (if applicable)
Birth Certificate(s) for household members as necessary
Any applicable court documents for child custody (if relevant)

Upload All Files Below

SECTION 6: Agreement and Declaration

By signing below, I certify that all information provided is accurate to the best of my knowledge. I understand that any false information may disqualify my application.

Primary Guardian Signature

Clear

Date

Secondary Guardian Signature

Clear

Secondary Guardian Signature Date

Please submit completed applications by March 31, 2025. Visit our website, Power2Parent.org, for additional information on scholarship eligibility and program updates. Thank you for choosing the EmpowerED Choice Scholarship to support your child’s

educational journey.