Income Affidavit for Scholarship
Introduction
I, [YOUR NAME], being duly sworn, depose and state as follows:
Statement of Facts
I am applying for a scholarship from [SCHOLARSHIP NAME] for [PURPOSE OF SCHOLARSHIP].
I am a student at [SCHOOL NAME] pursuing a degree in [FIELD OF STUDY].
My total household income for the past year is $[TOTAL HOUSEHOLD INCOME] before taxes.
My household consists of [NUMBER OF DEPENDENTS] dependents, including myself.
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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