FINANCIAL ASSISTANCE APPLICATION

NEXT LEVEL ACADEMY
FINANCIAL ASSISTANCE APPLICATION
Today's Date

MonthDayYear
Date
Sport
Grade
Student's Name
Date of Birth

MonthDayYear
Date
Address

Home Address

Street Address Line 2

City, State, Zip CodeState / Province

Postal / Zip Code
(C)
Email
example@example.com
Father
Mother
Marital Status (please check one):
Separate/Divorced ( ) Widowed

Marital Status (please check one):Single ( ) Married
Mother's Employer's Name
Mother's Employer's Address
Father's Employer's Name
Father's Employer's Address
Please list the first name, last name, gender and date of birth of all dependents living in your household.
Relationship
DOB
Name
Gender
DOB
Gender
DOB
Parent Signature

Clear
Student Signature

Clear
N NEXTTLEVEL A C A D E M Y
INCOME/EXPENSE WORKSHEET
Income (list all MONTHLY income/Verification may be requested)
GROSS MONTHLY INCOME FOR ALL ADULTS IN HOUSEHOLD
Child Support (if receiving)
Social Security/Disability (if receiving)
Welfare (if receiving)
Food Stamps (if receiving)
Unemployment (if receiving)
Alimony (if receiving)
Pension/Retirement (if receiving)
Housing Assistance (if receiving)
Other (please explain)
TOTAL INCOME
Expenses (list all monthly income/Verification may be requested)
Rent/Mortgage (monthly)
Vehicle Payments (monthly)
Utilities
Child Care
Food
Credit Cards
Medical
Child Support/Alimony
Insurance
Other (please explain)
TOTAL MONTHLY EXPENSES
Parent Signature

Clear
Student Signature

Clear
Should be Empty: