Fin aid app

Application for Financial Aid (Forms should be submitted no later than April 30.)

1. Name(s) of Student(s)

Year of graduation from high school

Last First

Tuition for next year

a) _________________________________ _____________ ______________

b) _________________________________ _____________ ______________

c) _________________________________ _____________ ______________

2. Family Information

Father

Mother

a) Name _________________ ________________ b) Home Congregation _________________ ________________ c) Pastor’s Name _________________ ________________ d) Occupation _________________ ________________ e) Employer _________________ ________________ f) Age _________________ ________________

g)

Parent’s Marital Status

_________________

h)

Parent’s Household Size

_________________

i) Number in College _________________

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rev. 4/12

3.

Last Year’s Income & Expense Information of Parents

a) b) c) d) e) f) g) h) i) j) k) l) m) n)

4.

Student’s Information

Exemptions Claimed Adjusted Gross Income from Form 1040/1040A/1040EZ US Income Tax Paid State and Local Tax Paid IRA/KEOGH/TSA Payments Itemized Deductions Father’s Income Earned from Work Mother’s Income Earned from Work Social Security Benefits AFDC/ADC Other Untaxed Income Medical/Dental Expenses Elementary/Junior High/Senior High/College Tuition Expected Income Next Year

$___________________ $___________________ $___________________ $___________________ $___________________ $___________________ $___________________ $___________________ $___________________ $___________________ $___________________ $___________________ $___________________ $___________________

Last Year

A. Income

Expected Next Year

$__________ $__________

1) 2)

Student Summer Income Student School Year Income

$_________ $_________

Savings/Investments Checking Account

$_________ $__________ $_________ $__________

B. Assets 1)

2) 5.

Asset Information of Parent(s)

a) Cash and Savings $_______________

b) Stocks, Bonds, Investments $_______________

c) Home Value $_______________

d) Home Debt $_______________

e) Other Real Estate/Investment Value $_______________

f) Other Real Estate/Investment Debt $_______________

g) Business/Farm Value $_______________

h) Business/Farm Debt $_______________

i) Other income (Example housing, social security, benefits, automobile, tuition assistance)

$_______________ 6.

State amount of tuition you feel you can pay during the year

$_______________

* Please attach a copy of your most recent tax return form as sent to the Internal Revenue Service.

(Parents who are divorced or separated and have joint custody should include tax forms from both custodial parents.) page 2

Address Verification

For Office Use Only

Parent Name________________________________

Date Received: _____________

Address_______________________________

Date Approved:_____________

_______________________________

Amount Granted:___________

Telephone: _______________________(Home)

Date Notice Sent:___________

_______________________(Cell)

Notes:

Please give additional information that you feel would assist Lakeside Lutheran High School in the consideration of your need for financial aid. In particular, please state any unusual circumstances that have or are affecting your ability to cover the full cost of tuition. _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ Please answer the following: 1)

Is financial aid available through your congregation?

_____Yes

_____No

2)

If “yes,” have you applied for this aid?

_____Yes

_____No

3)

If “yes,” how much aid was, or will, be granted to you?

$__________________

Parent signature:______________________________________

Date:_______________________

Student signature(s):___________________________________

Date:_______________________

___________________________________

Date:_______________________

___________________________________

Date:_______________________

Financial aid that is awarded will be pro-rated for late enrollees and for those students who transfer out of Lakeside Lutheran during the school year. page 3