Application - Our Lady of Mount Carmel School

Completion of this form in its entirety
Submission of a copy of your Federal Form 1040, 1040A, 1040 EZ pages 1 and 2
Payment of Registration Fee must be completed
Applicants must have been registered in the parish for the past six (6) months and have been making weekly contributions of $10 or more
Applicants must be current with Tuition Balances and Fees

Note: All information included in this form and accompanying attachments will be kept strictly confidential.

Scheffner Fund

Required *

Father's Name *

Father's Address *

Father's Telephone *

Mother's Name *

Mother's Address *

Mother's Telephone *

Number of Persons in Family *

Child's Name *

Grade *

School *

Tuition Paid *

Financial Aid Recieved *

Nominal Weekly amount (at least $10) you can consistently contribute to support the Parish *

Welfare of Relief Grants *

Last 12 Months
Last Month
N/A

Support Payments from separated or divorced spouse *

Last 12 Months
Last Month
N/A

Social Security, Disability, or Pensions *

Last 12 Months
Last Month
N/A

Unemployment Compensation *

Last 12 Months
Last Month
N/A

Amount paid by insurance companies for medical, auto, or home claims *

Last 12 Months
Last Month
N/A

Other sources of income *

State any anticipated fluctuation during the upcoming school year *

Summarize your reasons for why you feel you need financial assistance. *

Signature (your name as it would appear in your signature) *

Date *

Parent Email Address *

Our Lady of Mount Carmel School Website