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 or San Gabriel Academy. 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.
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STUDENT’S NAME |
GRADE IN SCHOOL |
SCHOOL STUDENT ATTENDS |
TUITION PER MONTH |
AMOUNT FAMILY & OTHERS CAN PAY
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AMOUNT OF HELP REQUESTED |
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NAMES OF ALL OTHER CHILDREN |
IN SCHOOL? (Circle One) |
SCHOOL ATTENDS |
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Yes No |
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Yes No |
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Yes No |
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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. We understand that failure on our part to meet our share of the monthly school bill will mean aid will not longer be granted.
3. We agree to support the White Memorial Church with our tithes and offerings.
4. We agree to be involved and help in at least one ministry of the White Memorial Church.
5. We agree to allow the school to release information to the church student aid committee pertaining to the progress of my child/children.
6. We acknowledge this is confidential information and used solely for identifying eligibility.
Signature of Parent/Guardian Date
Approved by Date