TUITION ASSISTANCE PROGRAM by mikeholy

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									                  RENAISSANCE CHRISTIAN SCHOOL of EXCELLENCE
                               Igniting Hope, Instilling Truth, Unleashing Potential
                                  11000 DeKalb Place * Charlotte, North Carolina * 28262
                  PH: (704) 323-5938 * Fax: (888) 574-2135 * Email: charlotte@RenaissanceChristian.net



                              TUITION ASSISTANCE PROGRAM
    APPLICATION DUE DATES           All forms must be postmarked no later than the due dates below

    March 31st                       Application deadline for Returning and New Families


     Number of           10%              15%              20%               25%              30%           40%
 Dependent Children   Scholarship      Scholarship      Scholarship       Scholarship      Scholarship   Scholarship
         1             $60,000.00       $53,600.00       $47,200.00        $40,800.00      $34,400.00    $28,000.00
         2             $70,000.00       $63,600.00       $57,300.00        $50,900.00      $44,500.00    $38,100.00
         3             $80,000.00       $73,600.00       $67,200.00        $60,800.00      $54,400.00    $48,000.00
         4             $90,000.00       $83,600.00       $77,300.00        $70,900.00      $64,500.00    $58,100.00
         5            $100,000.00       $93,600.00       $88,200.00        $80,800.00      $74,400.00    $68,000.00
         6            $110,000.00      $103,600.00       $99,300.00        $90,900.00      $84,500.00    $78,100.00



                 READ ALL DIRECTIONS BEFORE BEGINNING TO FILL OUT THIS FORM
1. A custodial parent, step-parent, or guardian must complete and sign the application form.
2. Complete one form per family. If there is more than one child in the family applying for aid
   they are all to be included on a single form.
3. Answer items completely and honestly. Do not leave any item blank unless it does not apply to
   the family. Feel free to attach any explanation which may help us better understand your family
   situation.
4. If projected 2011 income/expense varies significantly from 2010 you should attach an
   explanation referring to the appropriate numbered line.
5. Information on this form is confidential and will only be used to determine financial need.



             PLEASE INCLUDE THIS INFORMATION WITH YOUR APPLICATION

A) A copy of ALL pages of your 2010 Federal Tax Return, including all schedules. For e-filers and
   tele-filers, include a copy of the on-line worksheet.
B) Copies of ALL 2010 W-2's, Schedule C and 1099's for parent/guardian/applicants. No copies will
   be returned.
C) IMPORTANT: If the above items do not accompany this application your application will
   not be processed.




                       “Who in His great mercy, gave us a new birth.” ~ I Peter 1:3
                        RENAISSANCE CHRISTIAN SCHOOL of EXCELLENCE
                                   Igniting Hope, Instilling Truth, Unleashing Potential
                                     11000 DeKalb Place * Charlotte, North Carolina * 28262
                     PH: (704) 323-5938 * Fax: (888) 574-2135 * Email: charlotte@RenaissanceChristian.net



                              TUITION ASSISTANCE APPLICATION
    Circle One: FATHER      STEP-FATHER      GUARDIAN        Circle One: MOTHER        STEP-MOTHER       GUARDIAN
Social Security No.                Phone                     Social Security No.                        Phone
Name                                                          Name

Address                                                       Address

City                                State     Zip             City                              State         Zip

Email:                                                        Email
Employed By                                 Number of Years Employed By                                    Number of Years

                    Number of Persons Residing in Household for the 2011-2012 School Year
                       Parents/Guardians (   ) Other (  ) Children (   ) List all Children below

                                                     DEPENDENTS
Child's Last Name           Child's First Name                 M.I.      Date of     Sex Name of School Student Grade
                                                                          Birth           will Attend 2010-2011
1.
                            SS#
2.
                            SS#
3.
                            SS#
4.
                            SS#
5.
                            SS#
6.
                            SS#

                                                    EARNED INCOME
Gross Federal Earned Income during 2010 - Applicants should attach a copy of
their W-2's and Federal 2010 income tax return                                            2010 Actual      2011 Estimated
          NO INCOME CODE               Father/Stepfather/Male Guardian
                                       Earned Income                                   $_____________.00   $____________.00
A. Desceased
                                       REASON NO INCOME LISTED                                _____             _____
B. Retired
C. Divorced & Remarried                Mother/Stepmother/Female Guardian
D. Seperated or Divorced and Not       Earned Income                                   $_____________.00   $____________.00
Living with the Family
                                       REASON NO INCOME LISTED                                _____             _____


                           “Who in His great mercy, gave us a new birth.” ~ I Peter 1:3
E.    Disabled or Sick                   Other persons contributing to household
F.    Unemployed                         income: excluding grandparents
G.    Stay Home Parent                   Relationship to applicant:                $_____________.00   $____________.00
H.    Other: _________________________

                                    DO YOU OWN ANY OF THE FOLLOWING?
___   Yes   ___   No        BUSINESS – Attach Schedule C or C-EZ (Form 1040)
___   Yes   ___   No        FARM – Attach Schedule F (Form 1040)
___   Yes   ___   No        RENTAL PROPERTY – Attach Schedule E (Form 1040)
___   Yes   ___   No        S CORPORATION – Attach Schedule E (Form 1040, Form 11205 and Schedule K-1)
___   Yes   ___   No        PARTNERSHIP


OTHER INCOME                                                                         2010 Actual       2011 Estimated
1. Welfare Income/Food Stamps (Annual Amount)                                      $_____________.00   $____________.00

2. Unemployment Benefits (Annual Amount)                                           $_____________.00   $____________.00

3. Total Social Security, Retirement, Insurance, Disability, Veteran's Benefits
    received by ALL family members (including children) (Annual Amount)            $_____________.00   $____________.00

4. Alimony Plus Child Support from any other source (Annual Amount)                $_____________.00   $____________.00

5. Rental Income You Receive (Annual Amount)                                       $_____________.00   $____________.00

6. Military Income (Annual Amount)                                                 $_____________.00   $____________.00

7. Interest Income (Annual Amount)                                                 $_____________.00   $____________.00

8. Dividend Income (Annual Amount)                                                 $_____________.00   $____________.00

9. Other Income Received (Annual Amount) (Indicate Source)                         $_____________.00   $____________.00

OTHER EXPENSES
1. Rental – Amount Paid (Annual Amount)                                            $_____________.00   $____________.00

2. Mortgage Payment – Amount Paid (Annual Amount)
   (include second mortgage, home equity and loan payments)                        $_____________.00   $____________.00

3. Insurance and Tax Amount – If paid separartly from mortgage (Annual Amount)     $_____________.00   $____________.00

4. Child Care Cost (Paid by parents) (Annual Amount)                               $_____________.00   $____________.00

5. Grade/High School Costs (paid by parents) (Annual Amount)                       $_____________.00   $____________.00

6. Trade School/College/University Costs (paid by parents) (Annual Amount)         $_____________.00   $____________.00

7. Student Loan Payments (Annual Amount)                                           $_____________.00   $____________.00

8. Child Support – Amount Paid                                                     $_____________.00   $____________.00

9. ANNUAL Medical Expenses (docter, dental and medicines only) not reimbursed
   by insurance (If over $3000, attach an itemized explanation of all medical
   expenses not reimbursed by insurance)                                           $_____________.00   $____________.00

10. Medical Insurance Premiums Paid by Employee/Individual (Annual Amount)         $_____________.00   $____________.00

11. Credit Card Expense Principal and Interest (Annual Amount)                     $_____________.00   $____________.00

12. Automobile Loan or Lease Payments (Annual Amount)                              $_____________.00   $____________.00

13. Auto Insurance (Annual Amount)                                                 $_____________.00   $____________.00



                             “Who in His great mercy, gave us a new birth.” ~ I Peter 1:3
                 RENAISSANCE CHRISTIAN SCHOOL of EXCELLENCE
14. Charitable Contributions (Annual Amount)                                           $_____________.00   $____________.00

15. Number of Exemptions Claimed on Federal Tax Return                                 $_____________.00   $____________.00


ASSETS
1. Checking and Savings Accounts – List the current amount in accounts held by
   custodial parents (Exclude money in an IRA or retirement accounts)                  $_____________.00   $____________.00

2. Other Financial Assets (Stocks, bonds, mutual funds, CD's, etc.) - held by
   custodial parents (Exclude money in any IRA or retirement accounts)                 $_____________.00   $____________.00



     As of 12/31/2010               HOME                    FARM                 OTHER REAL                OTHER REAL
 If owned, year purchased                                                          ESTATE                    ESTATE
Estimated Market Value       $_____________.00     $_____________.00        $_____________.00         $_____________.00
Purchase Price               $_____________.00     $_____________.00        $_____________.00         $_____________.00
Unpaid Mortgage              $_____________.00     $_____________.00       $_____________.00          $_____________.00
                                 If you require more room, please attach additional pages

                        PLEASE INCLUDE THIS INFORMATION WITH YOUR APPLICATION
         Failure to include this information may exclude your family from any tuition assistance.
    A) A copy of ALL pages of your 2010 Federal Tax Return, including all schedules.

    B) Copies of ALL 2010 W-2's, Schedule C and 1099's for individuals listed as parent/guardian/applicants.
       No copies will be returned.


I certify that all of the above information is true and correct and that all income is reported. I understand
that this information is being given for the reduction of academic tuition from Renaissance Christian School
of Excellence and that the above information may be verified. If income verification does not match data
reported on the assistance application form, I understand that I will be required to pay the difference since
the date of initiation of the Tuition Assistance Program.


______________________________________________________          _________________________________________________________
Parent's or Guardian's Signature                                Parent's or Guardian's Signature:

______________________________________________________          _________________________________________________________
Parent's Printed Name                                           Parent's Printed Name


                          Address: ___________________________________________________________

              Phone: ____________________________ Email: _______________________________________________



                                                    For RCSE ONLY

Received: _________________________________                              Date Reviewed: ____________________________

Total Annual Income: _____________________                               Maximum Total Tuition: ___________________



                            “Who in His great mercy, gave us a new birth.” ~ I Peter 1:3

								
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