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THE BELVEDERE COVE FOUNDATION

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Parents/Guardians Scholarship Application Additional Information Form

Do 1st and 2nd parents/guardians live at the same address? *

Yes

No

Please list the names and ages of your additional children/dependents (if any):

Parental Statement: Please provide any additional information you feel are relevant to this application including spousal status, extenuating circumstances, and existing demands on family income

Thank you for submitting additional information for your child's scholarship application

The Belvedere Cove Foundation

P.O. Box 150180
San Rafael, CA 94915-0180
info@belvederecovefoundation.org

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The Belvedere Cove Foundation is an exempt organization as described in Section 501(c)(3) of the Internal Revenue Code; EIN# 68-0010945

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