Income Affidavit for Scholarship

Income Affidavit for Scholarship

Introduction

I, [YOUR NAME], being duly sworn, depose and state as follows:

Statement of Facts

  1. I am applying for a scholarship from [SCHOLARSHIP NAME] for [PURPOSE OF SCHOLARSHIP].

  2. I am a student at [SCHOOL NAME] pursuing a degree in [FIELD OF STUDY].

  3. My total household income for the past year is $[TOTAL HOUSEHOLD INCOME] before taxes.

  4. My household consists of [NUMBER OF DEPENDENTS] dependents, including myself.

  5. My household's financial situation is as follows: [BRIEF DESCRIPTION OF HOUSEHOLD'S FINANCIAL SITUATION].

Sworn Oath

I solemnly swear under penalty of perjury that the information provided in this affidavit is true and accurate to the best of my knowledge and belief.

[YOUR NAME]

Date: [DATE SIGNED]


Notarization

State of [STATE]

County of [COUNTY]

On this [DATE] day of [MONTH], [YEAR], before me, a Notary Public in and for said County and State, personally appeared [YOUR NAME], known to me to be the person whose name is subscribed to the foregoing instrument, and acknowledged that [HE/SHE/THEY] executed the same for the purposes therein contained.

Witness my hand and official seal.

Notary Public

[NOTARY SEAL]

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