Parent(s) Name(s):

Phone(h):

Phone(w):

Complete Address:

Occupation(s):

Best time and place to call you:

Are you 100% responsible for tuition? If not, please explain:

Have you received your TLA from school? If not please explain:

Student Name(s)

Grade

KG # of Days

2003-2004 Tuition Excluding TLA Amount

$

$

$

$

Total 2003-2004 Tuition Excluding Discounts:

$

If currently enrolled: 02-03 tuition per contract: $        /mo   x      months=$        /yr

Income/Expense Projections 8/03 – 7/04

Monthly

Annual

Total Household Income:

$

x 12 mos=

$

Total Expenses:

$

x 12 mos=

$

Net Income:

$

x 12 mos=

$

Tuition amount willing to pay for 2003-04:

$

x 12 mos=

$

Total tuition adjustment requested for 2003-04:

$

Other Resources

Individual/relative making tuition contribution:

$

Equity in real estate:

$

Savings:

$

Other:

$

Monthly Household Income Worksheet – 2003-2004 school year

Mothers Net**

$

Alimony

$

School Grant/Loans

$

Fathers Net**

$

Rental Income

$

Dividends/Interest

$

Child Support

$

AFDC/Soc. Sec

$

Trusts/Parents/Grandparents

$

Other (specify)

$

Total Monthly Income

$