2019/20 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: *
2015/2016 Tuition:*
Name of Child: *
Age of Child: *
School: *
2015/2016 Tuition:*
Name of Child: *
Age of Child: *
School: *
2015/2016 Tuition:*
Name of Child: *
Age of Child: *
School: *
2015/2016 Tuition:*
Name of Child: *
Age of Child: *
School: *
2015/2016 Tuition:*
Name of Child: *
Age of Child: *
School: *
2015/2016 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.:*