2021/22 REQUEST FOR TUITION ASSISTANCE

All information submitted will be kept strictly confidential by members of the tuition committee.

Please submit the completed form along with a copy of your last year’s income tax return showing
your annual income to Holy Family School as soon as possible for processing.

    Name of BOTH parents or guardians

    Full Name of Parent or Guardian:*
    Full Name of Parent or Guardian*

    Children in Family

    Name of Child: *
    Age of Child: *
    School: *
    2020/2021 Tuition:*
    Name of Child: *
    Age of Child: *
    School: *
    2020/2021 Tuition:*
    Name of Child: *
    Age of Child: *
    School: *
    2020/2021 Tuition:*
    Name of Child: *
    Age of Child: *
    School: *
    2020/2021 Tuition:*
    Name of Child: *
    Age of Child: *
    School: *
    2020/2021 Tuition:*
    Name of Child: *
    Age of Child: *
    School: *
    2020/2021 Tuition:*

    Parent Details

    Status: *
    Children live with *
    Father's Occupation*
    Gross Salary $*
    Place of Employment*
    Mother's Occupation*
    Gross Salary $*
    Place of Employment*
    Family Income*
    Assets (What you own)*

    Liabilities

    Home Mortgage or Rent: *
    Automobile: * *
    Professional or Union Dues: * *
    Medical: *
    Alimony: *
    Child Support: *
    Child Support: *
    Auto Insurance: *
    Auto Insurance: *
    Utilities: *

    General Info

    Do you contribute regularly to your church?: * YesNo
    Approx. Amount * *
    Do you have household help and/or child care?: * YesNo
    Approx. Amount *
    Do you belong to a social club(s)? * YesNo
    If Yes, list clubs below *
    Indicate approximate yearly amount: *
    Do you belong to any church parish organizations? * YesNo
    If Yes, list organizations below *
    How often do you attend Sunday Mass? * Each WeekendOccasionallyRarelyNever

    Additional Information

    State amount of the total school tuition you feel you can pay?: * *
    Please add any additional information which you feel the Tuition Committee should consider: *
    Please list all of the donated time you have given this past year at the school:*
    Please upload a copy of your income tax return from last year: *

    Submitted By

    Name of Applicant:*
    Address *
    Date of Application*
    Home Phone #*
    Work Phone #*
    Ext.:*