Tuition assistance application
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APPLICANT
Date of application *
MM
/
DD
/
YYYY
First name *
Middle name
Last name *
Address line 1 *
Address line 2
State *
ZIP code *
Email address *
Date of birth *
MM
/
DD
/
YYYY
Marital status *
Relationship to student *
Employment status *
Do you have a co-applicant? *
CO APPLICANT
First name
Middle name
Last name
Address line 1
Address line 2
State
ZIP code
Email address
Date of birth
MM
/
DD
/
YYYY
Marital status
Relationship to student
Employment status
STUDENT
First name *
Middle name
Last name *
Date of birth *
MM
/
DD
/
YYYY
Gender *
How much of this child's tuition can you and/or the co-applicant pay? *
Annual tuition support required from this child's non-custodial parent as a result of legal separation, divorce or paternity proceeding. Do not include child support payments.
TAXABLE INCOME
Number of adults living in this household? *
Number of children living in this household? *
Do you file a federal income tax return? *
Do you receive income reported on a W-2? *
Does the co-applicant file a federal income tax return? *
Does the co-applicant receive income reported on a W-2? *
Do you own any of the following?
NON TAXABLE INCOME
If you collect any nontaxable income, please select it below.
In case of other Nontaxable income, how much it represents per month?
If household members collect nontaxable social security income, please select it below.
CHANGE OF INCOME
 Do you anticipate a decrease in your annual income for 2022? *
What is your anticipated 2022 income? *
What is the co-applicant anticipated 2022 income?
Select the reason(s) for your reduced income (Select all that apply for applicant and co-applicant)
Applicant /Co applicant - Other Description
MONTHLY EXPENSES
Do you rent or own your primary residence? *
Monthly rent or mortgage payment (include principal, interest, taxes, and home insurance)
Do you own a second home (not including rental property)? *
Monthly home equity loan payments
Add all vehicles leased or owned (year, make/model and monthly payment), including any vehicle that does not have a monthly payment. Please do not include insurance expense. *
Total Credit Card Debt *
Total of all minimum amounts due on monthly credit card statements *
Monthly student loan payments for family members no longer attending college *
 Do you have other monthly loan payments (do not include cell phone, utilities, or other living expenses)? *
Monthly child support payments *
Health insurance premiums paid per month *
Health insurance premiums are paid
ANNUAL EXPENSES
Annual vehicle insurance expense *
Total annual out-of-pocket medical expenses not paid by insurance *
Charitable contributions - cash or checks per year *
Number of family members attending college beginning this fall *
Number of children for whom you pay child/day care expenses beginning this fall *
Number of people for whom you pay elder care expenses *
ASSETS AND LIABILITIES
Value of cash, savings, and/or checking accounts *
Value of stocks, bond investments, mutual funds, and/or certificates of deposit *
Value of your 529 plan accounts *
What is your expected contribution in 2021 to 529 plan accounts? *
Value of retirement plan assets *
What is your and/or your spouse's annual contribution to retirement plan assets? *
 What is the estimated value of your home? *
Provide the best estimate value of your home.
What is the amount you owe for your home? *
ADDITIONAL QUESTIONS
Use the space below to add any information or comments which you feel might be helpful in determining your family’s qualification for tuition assistance
When an applicant reports spending more than his/her declared annual income, the applicant must justify how he/she will be able to pay any portion of tuition. These statements will be reviewed both by the school. Are you in this case? *
In the following question, please provide an explanation of your financial situation and reason for seeking assistance.
Please use the space provided to offer an explanation of your financial situation. If your expenses exceed your income, justification must be provided and will be reviewed by the school. If possible, please use dollar amounts to justify your expenses.
Tuition assistance form - Terms and conditions
By clicking "Submit", you are agreeing to the terms and conditions. *
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