Tuition Assistance Special Circumstance Appeal Form for 2024-25

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The School understands that a family's special circumstances may warrant recalculation of their tuition assistance award, based on the family's current financial standing. This form is required from all families requesting a review of their tuition assistance decision.

CONTACT INFORMATION

The person completing this form is considered the primary contact. If you would like to include additional contact information, you will have the opportunity to list more information at the end of this form.

Primary Contact Last Name *

Primary Contact First Name *

Primary Contact Phone Number *

Primary Contact Email *

Your Child(ren's) Name and Grade *

SPECIAL CIRCUMSTANCE SITUATION

Check all that apply *

Unemployment or reduction in income for at least 8 weeks on or after January 1, 2024 (Required Documents: Signed and Dated Employer Letter (on company letterhead) List the following: last day of employment, total earnings, last copy of the pay statement, or amount of salary reduction)

Unusual, Unreimbursed Medical and Dental Expenses (Required Documents: Proof of payment - do not include voluntary medical procedures)

Separation or Divorce

Death of an immediate family member

Change in level of Elementary/Secondary Educational, Dependent Care, and Extended Family Support Expenses (Required Documents: Copies of canceled checks with name of institution or caregiver, proof of enrollment, statement on office letterhead from doctor/health care provider verifying care is required)

Other:

Required

How much additional assistance are you requesting above the tuition assistance already allocated by the school?

Family Letter (If you'd like to provide additional information, please write below.)

FAMILY INCOME AND EXPENSES

REQUIRED: In order for your appeal to be considered, you must complete the family income and expenses worksheet by clicking this link: https://tinyurl.com/y93e4m6t

Click on "File" and then "Download as" Microsoft Excel to complete it as an excel spreadsheet. If you do not have excel, feel free to send us your information in a word document or in the body of an email using the same categories and format of the original document.

Email the completed form to Helene Rhodes at hrhodes@cesjds.org

IMPORTANT INFORMATION

APPEALS SUBMITTED WITHOUT ALL REQUIRED DOCUMENTATION WILL BE DENIED

All supporting documentation must be sent to Helene Rhodes at hrhodes@cesjds.org

Please be aware that the school has limited resources, and filing an appeal may, or may not, result in a change to your tuition assistance award. The School may also request additional information.

If your appeal is approved, you shall receive notification via email with a link to your revised contract; revised contracts are due seven days thereafter. Families will be notified by April 19, 2024.

CERTIFICATION REQUIRED:

Type your name below to certify the information provided in this form *

Additional Contact information

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