Untitled Document

I,_________________________________________________________, hereby apply for financial assistance for: (parent or guardian)

NAME

RELIGION

GOING INTO GRADE

SCHOOL LAST ATTENDED

*AMOUNT REQUESTED

_____________________________________________________________________________________________

_____________________________________________________________________________________________

*Must show total dollar amount requested. Financial assistance applies to TUITION ONLY, not fees or tuition insurance.

PRESENT ADDRESS____________________________________________________________________________

street

city

state

zip

FATHER/GUARDIAN'S NAME_________________________________OCCUPATION_____________________

Employer____________________________________________________How long?_________________________

MOTHER/GUARDIAN'S NAME________________________________OCCUPATION_____________________

Employer___________________________________________________ How long?__________________________

With respect to any and all other persons living in your household, please give the following information:

NAME __________Age____Relationship_______**Status_________Amount_

______________________________________________________________________________________________

______________________________________________________________________________________________ **If student, name of school and amount of tuition paid.

List any financial assistance currently being received from the school they attend.

NAME AMOUNT OF ASSISTANCE

_______________________________________________________________________________________________

Has any other family member received financial assistance from Loyola? If so, give details:

_______________________________________________________________________________________________

List academic and extra-curricular activities in which your child is interested.

______________________________________________________________________________________________

FINANCIAL INFORMATION

PROJECTED INCOME - ANNUAL

Please list all income before deductions:

	Salary/Wages (Father, Step-father, Guardian)	____________________________________________

	Salary/Wages (Mother, Step-mother, Guardian)	____________________________________________

	Dividend/Interest Income	____________________________________________

	Alimony	____________________________________________

	Child Support	____________________________________________

	Social Security Benefits	____________________________________________

	List any other income and its source	____________________________________________

	TOTAL ANNUAL INCOME	____________________________________________

CHECKING/SAVINGS ACCOUNTS/ CD's/MUTUAL FUNDS

	NAME OF INSTITUTION	CURRENT BALANCE
	__________________________	___________________________
	__________________________	___________________________
	__________________________	___________________________
	__________________________	___________________________

Does the family own any other property such as stock, bonds, real estate, etc? If yes, please explain below and show approximate value.

______________________________________________________________________________________________

List all vehicles in the family.

MAKE

MODEL

YEAR

AMOUNT OWED

_______________________________________________________________________________________________

MONTHLY EXPENSES

MORTGAGE/RENT		______________________
UTILITIES		______________________
INSURANCE
	Medical	______________________
	Automobile	______________________
	Life	______________________
	Other	______________________
FOOD		______________________
CLOTHING		______________________
ENTERTAINMENT		______________________
MISCELLANEOUS		______________________

Please list all outstanding debts, such as credit cards, loans, etc..

TO WHOM OWED	BALANCE	MONTHLY PAYMENT
__________________________________	___________________	_________________
__________________________________	___________________	_________________
__________________________________	___________________	_________________
__________________________________	___________________	_________________
__________________________________	___________________	_________________
__________________________________	___________________	_________________
__________________________________	___________________	_________________
__________________________________	___________________	_________________

OTHER EXPENSES (List each)

__________________________________	___________________	_________________
__________________________________	___________________	_________________
__________________________________	___________________	_________________

TOTAL MONTHLY EXPENSES		_________________

NET MONTHLY INCOME/(LOSS)		_________________

If you anticipate an increase or decline in this year's income versus the IRS form you have attached, please explain in detail:

_____________________________________________________________________________________________

ADDITIONAL REMARKS/EXPLANATIONS

_____________________________________________________________________________________________

All applications will be held in strictest confidence. However, if we are able to secure funding from your Catholic parish, do we have permission to release your name to the parish priest? YES______ NO______

In which parish are you a member?__________________________________________________________________

If our child receives financial assistance, we understand that he/she must maintain a passing grade in all subjects, a minimum 2.0 grade point average, and that all school regulations must be observed to retain such assistance.

PARENT/GUARDIAN SIGNATURES

________________________________	________________________________
FATHER/GUARDIAN DATE	MOTHER/GUARDIAN DATE

**********************************************************************************************

NOTE: YOU WILL BE NOTIFIED BY LETTER OF YOUR STATUS FOR APPROVAL FOR ASSISTANCE. IF APPROVED, THE AMOUNT AWARDED WILL BE INDICATED AND A FORM OF ACCEPTANCE OR REJECTION WILL BE INCLUDED WHICH YOU MUST RETURN TO THIS OFFICE BY THE INDICATED DEADLINE.