Kyrene Special Programs Preschool
Financial
Assistance Application
Please fill out this application and return to: Kyrene Preschool
Student Name: ___________________________________________________________
Parent / Guardian: ________________________________________________________
Address:
Home Phone: ______________________ Work Phone: _________________________
School Student Will Attend or Currently Attends: _______________________________
The Following Information And Documentation Must Be Submitted. Incomplete Applications Will Not Be Considered.
Please complete the following section regarding your need for financial assistance with preschool tuition. List the names and ages of everyone living in your household, including yourself and children attending other schools. Also list parents and/or guardians responsible for the child even if they are not living in the same house. List all income received on the same line for the person who received it. List the gross income amount before deductions for taxes, social security, etc. A copy of your most recent Federal Tax Return showing annual gross income (w-2 forms are not acceptable) and your two most recent paycheck stubs must be attached for consideration.
|
Name (Last, First) |
Age |
Monthly earnings from work
(before deductions) |
Monthly welfare payments,
child support, AFDC & alimony |
All other income received
last month |
Total |
Lives with student (yes or
no) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Parent Signature: ___________________________________ Date: _______________