Lebanon Catholic School Scholarship Application

                                                  2006-2007

The following items must accompany this form for the application to be processed

•     Photocopy of the custodial family's 2003 Federal Income Tax Return

•     Photocopy of any supporting business tax returns (where applicable)

•     Pastor's letter verifying parish membership and attendance (may be mailed separately)

•     $ 15 check made payable to Lebanon Catholic School for the application fee

Return this completed form with ALL accompanying documents to LC by May 15, 2007

Custodial Parent (s): _________________________________________________________________

 

Home Address:        _________________________________________________________________

 

Home Phone Number:  _____________________________  Parish ____________________________

Please list all children who will be attending either Lebanon Catholic, or St. Joan of Arc in 2003-2004

Name_____________________________  Grade in 2004-05  ______   Birth Date   _____________

          _____________________________                                 ______                        _____________

          _____________________________                                 ______                        _____________

         _____________________________                                  ______                        _____________

          _____________________________                                 ______                       ______________

          ______________________________                               ______                       ______________

Please list other dependents living at home

Name  ____________________________                                                  Birth Date  ______________

            ____________________________                                                                       ______________

           _____________________________                                                                     ______________

 

Families seeking scholarship assistance from Lebanon Catholic School agree to pay at least one-quarter (25%) of the annual tuition at whatever applicable rate.  Lebanon Catholic does not, and will not provide 100% tuition for any family.

 

All families are welcome to apply for scholarship assistance.

 
 

 

 

 


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Please fill in any income related to the following sources:

Public Assistance                 ____________                     Social Security__________

Child Support                        ____________                     Rent Subsidy___________

Interest                                   ____________                     Dividends______________

Alimony                                 ____________                     Heat Subsidy___________

Rental Income                       ____________                     Disability______________

Other Income                        ____________                     Unemployment_________

                                               Vehicle (s) Owned/Leased

Year                         Make/Model                          Year                    Make/Model_________

Please identify persons supported on the INCOME listed above that have not been

previously listed  (e.g., parents who live with you).
 
                                                                                                                                          

 

Name _________________________ Age ___         Name __________               Age____

                                                       Monthly Expenses

Mortgage/Rent _____                         Utility Payments _____            Medical Expenses__________
Other (please briefly explain)          _______________________________

 

Medical Expenses _____                     Children In College _____       Unemployment _____
Other Reasons (please briefly explain) ___________________________________

Financial assistance is requested because (please check appropriate items and briefly explain (attach a separate sheet if necessary)

                                                                                                                                                                                              

 
 
 


Parent's Statement (this item MUST be filled in)

I can make a monthly payment of $___ toward my child's (or children's) education at Lebanon Catholic.
Parent Signature ___________________                                       Date ______________
Parent Signature ___________________               Date ______________

If you are Catholic, please remember to contact your pastor and ask for a letter indicating your parish

Membership and regular attendance.  Your pastor may give this letter to you to enclose with this form,

Or the letter may be sent directly to Lebanon Catholic, in care of the Principal’s Office.  Forms submitted for scholarship assistance are held in strict confidence and are not shared outside the Scholarship Committee.
 
 

 


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