St. James/Seton School
2017/2018 Application and Financial Form Instructions
We strive to provide a Catholic education for as many students as possible.
This application provides data to help guide our assistance process.
Application:
1. Verify that you are financially eligible using the Applicant Eligibility Scales.
2. Complete all information on the Application Form.
3. Sign and date the application.
4. Family must also apply for assistance from the Children’s Scholarship Fund if the deadline has not passed.
5. Family must also apply for the Free & Reduced Lunch Program.
Financial Information Form:
1. Complete the total number in household as of 12/31/16. Household includes you, your spouse, all children under 18, any elderly parents and others who live with you. TOTAL NUMBER IN HOUSEHOLD MUST MATCH HOUSEHOLD NUMBER ON 2016 FEDERAL TAX RETURN. If not, an explanation must be attached with dependent names and social security numbers. If your dependent names and social security numbers are listed on a separate attachment, please send it.
2. Provide official documentation of all income. Send only the first two pages of your federal tax return. PLEASE MAKE SURE THE SECOND PAGE OF YOUR 1040 IS SIGNED. Even if you file taxes electronically, we need your signature for our records.
For a free copy of your 1040 call the Internal Revenue Service at 1-800-908-9946.
Child support documentation can be obtained at www.nebraskachildsupport.com
Please provide 2016 summary.
3. We cannot accept W-2 forms, pay stubs, electronic filing “signature sheets” or state tax returns. If you received any form of public assistance, we require documentation for the full year (January through December) of 2016. This can be time-consuming to obtain, so start early.
4. You must provide proof of guardianship for all dependents (for example, birth certificates, court papers, etc) if their social security number is not listed on your taxes. Please sign and date the page to certify all information is accurate.
5. If you did not file taxes, provide all income documents and get your application form notarized. Please sign and date the page to certify all information is accurate.
6. It is an expectation of each family who receives assistance that they give back to SJS through time and talent to the fullest extent possible. Opportunities to volunteer are posted on I-Volunteer.
Make copies of your complete application packet for your records.
St. James/Seton School
Financial Assistance
2017-2018 Application Form
2017-2018 Application Guidelines
Who Can Be Considered for Tuition Assistance?
1. Families with a total family income that falls within the guidelines of the following eligibility scales.
INCOME ELIGIBILITY SCALE (1) - $1000 (maximum) Award per Student
Household Size / Maximum Eligible 2016 IncomeTwo / $29,637
Three / $37,296
Four / $44,955
Five / $52,614
Six / $60,273
Seven / $67,951
Eight / $75,647
Nine / $83,343
Ten / $91,039
INCOME ELIGIBILITY SCALE (2) - $500 (maximum) Award per Student
Household Size / Maximum Eligible 2016 IncomeTwo / $43,254
Three / $54,432
Four / $65,610
Five / $76,788
Six / $87,966
Seven / $99,171
Eight / $110,403
Nine / $121,635
Ten / $132,867
What is the Selection Process for Tuition Assistance?
1. All families who qualify financially and who submit a complete application with documentation will be considered for tuition assistance.
2. All families who apply must also apply for the free and reduced lunch program. (If Applicable)
3. All families who apply must also apply for the Children’s Scholarship Fund if the application deadline has not passed. (If Applicable)
** YOU WILL ONLY BE ELIGIBLE TO RECEIVE ASSISTANCE WHEN ALL STEPS ARE COMPLETED
St. James/Seton School
Financial Assistance
2017-2018 Application Form
*** This form does not guarantee assistance. ***
PARENT/GUARDIAN INFORMATIONLast Name / First Name / Middle Name / First Language:
□ English □ Spanish □ Other
Mailing Address / Apartment Number:
City / State / Zip / E-mail Address: (Use only if you check your email daily)
Home Phone / Work Phone / Cell Phone / Alternate Phone
STUDENT INFORMATION
Please provide the following information ONLY for the children for whom you are applying:
Child 1 / Child 2 / Child 3 / Child 4
Child’s Full Name
Child’s Date of Birth
Gender: Male or Female
Child’s School in 2017-2018
Child’s Grade Level 2017-2018
VERIFICATION
I certify that all the information provided on this form is true and complete to the best of my knowledge. I promise to pay my child’s school account in a timely manner, ensure at least 90% attendance of my child(ren), and comply with the standards and policies of St. James/Seton School. I understand that failure to comply with the above statements will result in the loss of my family’s assistance.
Signature of Applicant / Date
ST. JAMES/SETON SCHOOL
Financial Assistance
2017-2018 Application Form
*** This form does not guarantee assistance. ***
PARENT/GUARDIAN INFORMATIONLast Name / First Name / Middle Initial
Number of people in your household as reported on your 2016 Tax Return
Total Number of Adults: / Total Number of Children:
ALL 2016 INCOME MUST BE REPORTED. ATTACH SUPPORTING DOCUMENTATION.
Total number of people in household as of 12/31/16: ADULTS ______CHILDREN ______
INCOME SOURCE / ANNUAL AMOUNTAdjusted Gross Income reported on 2016 FEDERAL 1040 Taxes - Line 37(attach signed 1st two pages 1040) / $
Child Support Income (provide official documents)
www.nebraskachildsupport.com / $
Food Stamp Income (provide official documents) / $
Social Security Income (provide official documents) / $
Public Housing Assistance/Section 8 (provide official documents) / $
ADC/Public Assistance (provide official documents) / $
TOTAL HOUSEHOLD INCOME / $
Please attach a copy of your signed 2016 Federal 1040 tax return with dependents listed and proof of all income from 2016. Married couples filing separately must attach both 1040 forms. Failure to document income by the deadline may result in the loss of your assistance. Do not send State tax forms. For a free copy of your 1040 call the Internal Revenue Service at 1-800-908-9946.
I certify that all the information provided on this form is true and complete to the best of my knowledge. I promise to pay my child’s school account in a timely manner, ensure at least 90% attendance of my child(ren), and comply with the standards and policies of St. James/Seton School. I understand that failure to comply with the above statements will result in the loss of my family’s assistance
Parent signature: ______Date: ______
Complete this section ONLY IF YOU DID NOT FILE TAXES in 2016.
Provide official documentation of all 2016 income such as public assistance statements, child support documents, and Social Security statements.
Notary signature: ______Date: ______
Notary name printed: ______