Application for student aid

Please Print

White Memorial Church

School year _____________

name  ____________________________________ date _________________________

address ________________________________________________________________

city  __________________ zip  _______ phone _____________ e-mail: ___________

 

 

Statement of Eligibility

These funds are made available to students who are active, participatory members of the White Memorial Church to help families pay the tuition cost at White Memorial Elementary, San Gabriel or Glendale Academies. Student aid is supplemental. Parents and guardians are expected to pay a reasonable portion of tuition costs. In order to be eligible for this aid, the student must maintain a B average and good citizenship reports.  Recipients are expected to spend time working at a not-for-profit organization or have a paying, part time job.

 

STUDENT’S NAME

GRADE IN SCHOOL

SCHOOL STUDENT  ATTENDS

TUITION PER MONTH

AMOUNT FAMILY & OTHERS CAN PAY

 

AMOUNT OF HELP REQUESTED

 

 

 

 

 

 

NAMES OF ALL OTHER CHILDREN

IN SCHOOL?

(Circle One)

SCHOOL

ATTENDS

 

 

 

 

Yes        No

 

 

 

 

 

Yes        No

 

 

 

 

 

Yes        No

 

 

 

 

 

1.      We state that we believe the information we have submitted is correct to the best of our knowledge.

2.      We agree to pay our portion of the school bill each month, regularly and on time.

3.      We understand that failure on our part to meet our share of the monthly school bill will mean aid will not longer be granted.

4.      We agree to allow the school to release information to the church student aid committee pertaining to the progress of my child/children.

5.      We acknowledge this is confidential information and used solely for identifying eligibility.

                                                                                                           
Signature of Parent/Guardian                                        Date

                                                                                                           
Approved by                                                                         Date