Financial Assistance APPLICATION

All information on this application is intended to remain confidential and is to be used to determine financial assistance. Financial assistance is based upon need and the availability of funds and is not affected by race, gender, or national or ethnic origin.

Please fill out the application completely. Contact the school office with questions.

If you'd prefer to download and print paper copies of the Financial Assistance Application, click the button below.

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Enrollment Application

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FAMILY INFORMATION

Name of Adult Applicant:

Email:

Home Address:

City:

Phone:

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Name(s) & grade(s) of children enrolled in Immanuel Lutheran School whose tuition you are financially responsible for:

Name:

Grade:

Name

Grade

Name:

Grade:

Name:

Grade:

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EMPLOYMENT

Name (Father/Guardian):

Employer:

Name (Mother/Guardian):

Employer:

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We/I affirm that the information furnished on this application is correct to the best of our/my knowledge. We/I understand that Immanuel may ask for a copy of our/my latest federal income tax return to verify this information. We/I agree to notify the school officials if our/my salary or other financial considerations change between now and the end of the school year for which this application is being made.

Opt-In

I agree.

Signature of Applicant

Date:

Spouse's Signature

Date:

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FINANCIAL INFORMATION (Use 2023 Tax Form)

2023 Total Family Income (Form 1040 Line 22, 1040A Line 15, 1040EZ Line 4):

2023 Other Income not included above (housing allowance, pension, social security, AFDC, child support, workman's comp, alimony, taxable & nontaxable interest, etc:

CURRENT household monthly gross wages (all family members):

CURRENT household other monthly income (housing allowance, pension, social security, AFDC, child support, workman’s comp, alimony, taxable & nontaxable interest, etc.):

Total monthly income for all members form all sources:

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Because of certain endowments wishes, we must ask the following question:

Are you a member of Immanuel Lutheran Church, Lockwood?

Yes

If so, do you attend church regularly?

Yes

If your child was a student last year, did you complete the required volunteer hours?

Yes

If able, would you be willing to pay $25 toward your child’s education?

Yes

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Reason financial help is necessary:

Indicate below any special circumstances that the School Board needs to take into consideration in determining possible financial assistance for your family.

Message:

How much do you feel you will be able to contribute toward tuition and registration fees for each child enrolled at Immanuel?