CCS APPLICATION FOR FINANCIAL AID

PARENT INFORMATION

NAME OF PARENT OR

LEGAL GUARDIAN: ___________________________________________________________________

                                         First Name      Middle Initial                          Last Name

ADDRESS: _________________________CITY_____________________STATE____ZIP___________

HOME PHONE #____________________________ BUSINESS PHONE #________________________

PARENT’S PRESENT EMPLOYER (Indicate if unemployed:)________________________________________

PARENT’S PRESENT EMPLOYER (Indicate if unemployed:)___________________________________

STUDENT INFORMATION

PLEASE LIST BELOW ALL CHILDREN APPLYING FOR FINANCIAL AID. ONLY CHILDREN ENTERING GRADES K-12 ARE ELIGIBLE. STUDENT INFORMATION IS FOR THE SCHOOL YEAR FOR WHICH YOU ARE APPLYING. PLEASE NOTE IF FOSTER CHILD.

PLEASE INDICATE THE SCHOOL YEAR FOR WHICH YOU ARE APPLYING:

*NOTE THAT PARENTS MUST REAPPLY EACH SCHOOL YEAR                       _________________

FULL YEAR: ______                                             SECOND SEMESTER ONLY:____

FINANCIAL INFORMATION

YOU MUST SEND A COPY OF YOUR MOST RECENT FEDERAL INCOME TAX RETURN (FORM 1040). IF YOU WOULD LIKE A FREE COPY OF YOUR 1040, PLEASE CALL THE INTERNAL REVENUE SERVICE AT 1-800-829-1040. SELF EMPLOYED MUST INCLUDE A COPY OF SCHEDULE “C”. IF NO INCOME TAX RETURN IS AVAILABLE, YOU MUST SEND VERIFIABLE PROOF OF INCOME (SOCIAL SECURITY BENEFITS, A LETTER FROM YOUR EMPLOYER ON LETTERHEAD STATING YOUR YEARLY INCOME, ETC.)

**PLEASE NOTE THAT IF YOUR FINANCIAL CIRCUMSTANCES HAVE CHANGED AND YOUR INCOME TAX RETURN DOES NOT REFLECT THAT CHANGE, YOU MAY SUBMIT A LETTER STATING BRIEFLY WHAT THOSE CHANGES ARE. BE SURE TO ESTIMATE ANTICIPATED YEARLY INCOME. PLEASE INCLUDE DOCUMENTATION SUPPORTING THOSE CHANGES.

TAX YEAR IN WHICH INCOME WAS EARNED:_______________________

HOUSEHOLD SIZE: ADULTS___________ CHILDREN______________TOTAL______________

ADJUSTED GROSS INCOME:__________________________

INCOME (WAGES, SALARIES, TIPS, ETC.)

AS REPORTED ON W2S OR 1099 FORMS:      FATHER: $___________________________

                                                                             MOTHER: $___________________________

UNTAXED INCOME: PLEASE USE YEARLY AMOUNTS

SOCIAL SECURITY:                                                         $_________________________

AID TO FAMILY OF DEPENDANT CHILDREN:               $_________________________

CHILD SUPPORT FOR ALL CHILDREN                          $_________________________

WORKERS COMPENSATION                                          $_________________________

HOUSING, FOOD, AND OTHER LIVING

ALLOWANCES PAID TO MEMBERS OF MILITARY,

CLERGY, OR OTHERS                                                    $_________________________

OTHER NON-TAXABLE INCOME                                    $_________________________

TOTAL NON-TAXABLE INCOME                                    $_________________________

GRAND TOTAL OF ALL HOUSEHOLD INCOME $____________________

AN AFFIRMATIVE ANSWER TO ALL THE FOLLOWING QUESTIONS IS REQUIRED FOR SCHOLARSHIP ELIGIBILITY

☐        I promise to pay my child’s school account in a timely and responsible manner. I understand that failure to stay current with tuition payment may result in a loss of financial aid.

☐         I certify that the above student(s) is entering grades K-12 at Champion Christian School.

☐         I certify that all information on the CCS Financial Aid application is true and complete to the best of my knowledge and that all income was reported.

 _____________________________________________________ _____________________

   SIGNATURE OF PARENT/GUARDIAN                                                    DATE

PLEASE PROVIDE NAME(S) & SIGNATURE(S) FOR ANY ADDITIONAL PARENT(S) OR GUARDIAN(S):

 _____________________________________________________ _____________________

   SIGNATURE OF PARENT/GUARDIAN                                                    DATE

______________________________________________________ _____________________

   SIGNATURE OF PARENT/GUARDIAN                                                    DATE