Account Number: ___________

Checking Account Application

Name: ______________________________

Date: _________________

Please initial by each box:

__________
_
__________
_
__________
_
__________
_

I understand that this checkbook is my responsibility and I

agree to take it very seriously.
I will carefully fill out my checkbook according to my teachers
instructions.
I will always be honest when I am writing in my checkbook and I
understand that if I choose to commit fraud my checking
account will be automatically set to $0.
I understand that I must have money in my checking account in
order to participate in rewards.

Proof of Checkbook skills:

Check
No.

DATE

Description OF TRANSACTION

PAYMENT (-)

DEPOSIT (+)

BALANCE

Please List One Reference of someone who will confirm your

trustworthiness:
Name:_________________________________________________________
Copy this pledge on the lines below:
I promise that I will be responsible and honest with my scholar dollar
checkbook and will do my best to be a contributing member of our
classroom.
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Applicant Signature: _______________________________________________

Account Number: ___________

By completing and signing this application I agree follow all the
rules of the scholar dollar banking system and understand that if I
choose to break a rule I will lose my money in my checkbook:

Applicant Signature: _______________________________________________