Financial Aid Scholarship Application 2017-2018

This application is for families of students applying to Life Christian School, for grades K-6th grade in the 2017 – 2018 school year. Please fill out all applicable sections of this application – incomplete applications will not be considered for financial aid.

To complete this application you will need to include:

  1. Complete copy of the 2016 Federal Income Tax Return Form 1040, 1040A, or 1040EZ (as filed with the IRS) for individuals listed in Sections A and B. Recaps and/or Summary Forms are not acceptable. If you file Schedule A, C, E, or F, you must provide copies.
  2. Copies of all 2016 W-2 Wage and Tax Statement Forms, all 2016 1099/1099R for Interest/Dividends, Pensions and/or Misc. Income Forms for Individuals listed in Section A and B.
  3. Documentation of TOTAL AMOUNTS received in 2016 for all Non-Taxable Income.
  4. This application form filled out in its entirety, signed and dated by the Parent(s) or Guardian(s) listed in Section A and B.
  5. Return this completed application and documentation by May 30, 2017 to:

Life Christian School (Pastor David)

8881 CR 3918

Athens, TX 75752

Financial Aid Scholarship Application • 2017 – 2018

• IMPORTANT: Print clearly and neatly with a ball point pen •

A PARENT, GUARDIAN or OTHER ADULT RESPONSIBLE FOR TUITION / B PARENT, GUARDIAN or OTHER ADULT RESIDING WITH PARENT A
Check one: Father  Mother  Stepfather  Stepmother  Other Adult 
______
Last Name First Name MI
______(_ _ _) ______
Social Security Number Age (Area Code) Home Phone
______
Address Apt. #
______
City State Zip
( ______) ______
(Area Code) Work Phone E-mail address
______
Employed by How Long? / Check one: Father  Mother  Stepfather  Stepmother  Other Adult 
______
Last Name First Name MI
______(_ _ _) ______
Social Security Number Age (Area Code) Home Phone
______
Address Apt. #
______
City State Zip
( ______) ______
(Area Code) Work Phone E-mail address
______
Employed by How Long?
C DEPENDENTS (DO NOT LEAVE BLANK)
Number of dependent children who will attend a tuition charging school: Pre-K, elementary school, secondary school, or college in fall 2017.
If you have additional dependents, please check the box to the right and attach a separate sheet listing information for these dependents.  Additional Dependents

1
Last Name First Name MIAgeRelation to Parent/Guardian A

2
Last Name First Name MIAgeRelation to Parent/Guardian A

3
Last Name First Name MIAgeRelation to Parent/Guardian A
DHOUSEHOLD INFORMATION
1. Number of individuals who will reside in my/our household during the 2017-2018 school year:
Parents/Guardians ______Children ______Other* ______
*If Other, please explain relation to Parent ______/ 2. Current marital status/housing arrangement of Parent/Guardian A:
a.  Single, never Married* d.  Divorced* g.  Other
b.  Married e.  Remarried*
c.  Widowedf.  Separated*
*If Divorced, Remarried, Separated or Single, please complete Section E.
E DIVORCED, SEPARATED OR SINGLE PARENTS (TO BE COMPLETED BY PARENT OR GUARDIAN LISTED IN SECTION A)
1. Date of separation (Month/Year) ______
2. Date of divorce (Month/Year) ______
3. Non-custodial parent ______
Last Name First Name MI
4. Do you receive or pay child support?  Receive $______per year
 Pay $______per year
 Neither / 5. Who claimed student as a tax dependent in 2016? ______
6. Who is responsible for the tuition for the dependent(s) listed in Section C?
 Father ______% Name ______
 Mother ______% Name ______
 Other ______% Name ______
*If tuition is shared, each responsible party must complete a Student Aid Form (SAF).
F TAXABLE INCOME
The 2016federal tax return for student’s household was:
 Filed
 Not filed yet (Please submit a copy by April 15)
 I/we do not file. I/we only receive non-taxable income
Actual 2016 / Estimate 2017
1. Total number of exemptions claimed on Federal Income Tax form:
2. Parent/Guardian A total taxable income from W-2 wages. (Total income for Parent A only) / $ / $
3. Parent/Guardian B total taxable income from W-2 wages. (Total income for Parent B only) / $ / $
4. Net business income from self-employment, farm, rentals, and other businesses. (please complete Section J) (Attach Schedules C, E, and/or F from your IRS 1040) / $ / $
5. Other non-work taxable income from interest, dividends, alimony, unemployment, and non-business income. / $ / $
6. Allowable “Adjustments to Income” as reported on you IRS 1040, 1040A, or 1040EZ. / $ / $
7. Total “Adjusted Gross Income” as reported on your IRS 1040, 1040A, or 1040EZ. / $ / $
8. Total Tax Paid as reported on your IRS 1040, 1040A or 1040EZ. / $ / $
9. Medical/Dental expenses as reported on Schedule A line 1 of your IRS 1040 Form. / $ / $
G NON-TAXABLE INCOME
List the total amount received from 1/1/2016-12/31/2016for all recipients in household.
DO NOT list monthly amounts. / Actual 2016 / Estimate 2017
1. Child support / $ / $
2. Cash Assistance (TANF) / $ / $
3. Food Stamps / $ / $
4. Medicaid received / $ / $
5. Social Security income (Provide documentation for all recipients in household.)
a. Social Security income (SSA/SSD, etc.) received
b. Social Security income (SSI ONLY) total received / $
$ / $
$
G NON-TAXABLE INCOME CONT.
6. Student loans and/or grants received for PARENT’s education.
(Not college dependents or students listed in Section C.)
a. total student loans and/or grants received
b. total used for household expenses / $
$ / $
$
7. Housing Assistance
a. Sec. 8, HUD, etc. total received
b. Religious Housing Assistance total received / $
$ / $
$
8. Other non-taxable income
(Workers’ Comp., Disability, Pension/Retirement, etc. Identify source(s). / $ / $
9. Loans/Gifts from friends or relatives / $ / $
10. Personal Savings/Investment Accounts used for household expenses (Do not include totals listed in Section I) / $ / $
11. Total non-taxable income / $ / $
*You must provide 2016 YEAR-END documentation for items 1-8; either a YEAR-END statement from the appropriate Public Agency, or documentation showing totals from 1/1/2016 - 12/31/2016.
HHOUSING INFORMATION (DO NOT LEAVE BLANK)
1. Do you rent or own your residence?  Rent  Own (go to line 3)
2. If renting, what is the monthly rental payment? $ ______
a. Amount paid by household $ ______per month
b. Amount paid by other source(s) $ ______per month
3. If you own your residence
a. What is the current market value? $ ______
b. What is the amount still owed, including home equity loans? $ ______
c. What is the monthly mortgage payment?$ ______per month
IASSETS & INVESTMENTS (AS OF 12/31/16)
1. Total amount in cash, checking, and savings accounts $ ______
2. Total value of money market funds, mutual funds, stocks, bonds, CDs, or other securities $ ______
3. Total value of IRA, Keogh, 401K, SEP or other retirement accounts $ ______
4. If you own real estate other than your primary residence,
a. What is the fair market value? $ ______
b. What is the amount still owed? $ ______
5. Do you own a business?  Yes  No If Yes, please complete Section J.
a. What is the fair market value of your business? $ ______
b. What is the amount still owed? $ ______
6. Do you own a farm?  Yes  No If Yes, please complete Section J.
a. What is the fair market value of your farm? $ ______
b. What is the amount still owed? $ ______
JBUSINESS INCOME (2016 TOTALS)
Schedule C Schedule E Schedule F
1. What is your total GROSS business taxable income? $______$______$______
2. What is your total NET business taxable income/loss? $______$______$______
3. If your business pays your home rent or mortgage, what is the annual total? $______
4. If your business pays for your personal automobile, what is the annual total? $______
5. If your business pays any portion of other personal expenses, list total amount and explain in SECTION M. $______
6. If you own rental property: What was the total amount of Rental Income received? $______
KUNUSUAL CIRCUMSTANCES
Check all that apply to your situation within the past 12 months:
 Loss of job  Death in the family Income reduction
 Illness or injury Recent separation/divorce Shared custody
 Change in family living status Change in work status  High debt
 Child support reduction  Bankruptcy Medical/Dental expenses
 College expenses  Shared tuition  Other (Explain in Section M)
L INVESTMENT IN YOUR CHILD’S / CHILDREN’S EDUCATION
Please thoughtfully consider your family’s financial situation and balance that with the financial situation of the school in determining the amount you can contribute towards your child’s / children’s education at Life Christian School. Please note that Life Christian School does not give out financial aidscholarships greater than 50% of tuition.
I am willing to invest $______in my child’s / children’s education.
Please provide additional information on a separate sheet of paper that could be helpful in awarding scholarship funds to your family.
M EXPLANATIONS (USE THIS SPACE TO EXPLAIN ANY ANSWERS WHICH MAY NEED CLARIFICATION)
NCERTIFICATION, AUTHORIZATION AND DOCUMENTATION CHECKLIST
(IF ANY OF THE FOLLOWING IS MISSING, YOUR APPLICATION WILL NOT BE CONSIDERED COMPLETE)
If you have filed a
2016 IRS Form 1040: / If you have NOT YET filed a
2016 IRS Form 1040: / If you did not FILE a 2016 IRS Form 1040 AND RECEIVED ONLY NON-TAXABLE INCOME:
A complete photocopy of your 2016Form 1040, 1040A, or 1040EZ (as filed with the IRS, including all Schedules). 2016W-2 Forms, 20161099/1099R Forms for individuals listed in Section A & B. / A complete photocopy of your most recent Form 1040, 1040A or 1040EZ (as filed with the IRS, with all Schedules). W-2 Forms, 1099/1099R Forms for individuals listed in Section A & B.
Please submit a copy of your 2016 IRS Form 1040 by May 30, 2017. / Photocopies of your 2016YEAR-END Social Services statement (TANF, etc.), Food Stamp documentation, Housing Assistance documentation, Student Loans and/or grant documentation for parent’s education, Social Security income statements showing TOTAL AMOUNT received in 2016for ALL members of the household.

I/we declare that the information on this form is true, correct, and

complete to the best of our knowledge.

Parent/Guardian A ______Date ______

Parent/Guardian B ______Date ______

______

P.O. 2344 • 8881 CR 3918, Athens, Texas 75752 • (940) 206-9798