Application for Financial Assistance for Meyer Preparatory School 2022-2023

Student's Last Name *
Family Information
Parent/Gaurdian Information
Parent #1 *
Parent #1 Address *
Parent #1 Email *
example@example.com
Parent #1 Social Security #: *
Parent #1 Cell: *
Parent #1 Date of Birth: *

Month Day Year
Date
Parent #1 Birthplace: *
Parent #2 Name:
Parent #2 Address
Parent #2 Email
example@example.com
Parent #2 Social Security
Parent#2 DOB

Month Day Year
Date
Parent #2 Cell
Parent #2 Birthplace:
Home Phone of Student's Residence: *
Maiden Name:
Marital Status: *
Non-Custodian Parent:
Amount of Court Order Support per month
Date of divorce or separation:

Month Day Year
Date
Who takes the child/ren as a tax deduction on federal income tax?

List all children in family including those in college. *

	Child's Name:	Birth Date:	Grade (school year 2022-2023)	If child will not attend Meyer what school will they attend?	What is their current school? (2021-2022 year)

If you have children of school age (K-12) who will not be attending our school for the year 2022-2023, please explain why they are not attending our school.

	Gross Amount
Net Wages/Salaries (Parent 1)
Net Wages/Salaries (Parent 2)
Cash income
Tips
Net business income (supply documentation of your interest in business)
Dividends, interest
Rental income (supply documentation for each property)
Other taxable income/losses
Child support (you are receiving)
Alimony (you are receiving)
Trust or other income (support from family, loans and inheritance, etc.)
Pension (Parent 1)
Pension (Parent 2)
Social security benefits
Other government benefits received (SSI, food stamps, Medicare, or Medicaid.)

	Gross Amount
Rent or mortgage (circle applicable description)
HOA/Maintenance fees
Real estate taxes (if not included in mortgage)
Electric
Water
Garbage
Cable
Other utilities
House maintenance/repairs
Food - Groceries
Food - Outside Home
Clothing
Laundry/dry cleaners
Medical/dental expenses
Car Repairs
Car Payments
Transportation not including car payments/repairs
Recreation and entertainment
Insurance-homeowners (not included in mortgage)
Insurance-life
Insurance-health
Insurance-auto
Insurance-other
Nanny/Au Pair/Baby Sitter
Housekeeper
Monthly Credit card payments. Do not include expenses already listed on this form.
Alimony (if you are paying)
Child support (only put if you are paying)
Expenses for others (explain detailsÉwho & why)
Sports, music, dance, gym, etc. lessons for ALL children
CURRENT Monthly Payment for Private School 21-22
Payment for before or after school care
Taxes (if not withheld from paycheck )
Other Taxes

UPLOAD SECTION AND DOCUMENTATION

Please note that you must supply the following information with your completed Financial Assistance Application. All information must be LEGIBLE
Copy of completed 2019 2020 and 2021 Personal Federal Income Tax return. 2021 Tax return due by April 18, 2022. Tax returns from 2019 and 2020 are due by January 14, 2022. Do not submit tax returns that you previously submitted.

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If you own your own company upload a copy of your completed Profit/Loss statement for 2021.

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Copy of ALL applicants pay stubs for END of MONTH for the past 2 months

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Complete and sign IRS Form 4506 (https://www.irs.gov/pub/irs-pdf/f4506.pdf)

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IF YOU OWN YOUR OWN COMPANY: copy of your completed 2019, 2020, 2021 Corporate Federal Income Tax return and K-1.

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Copy of all W-2 forms received for income earned in 2021.

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Copy of all 2021 - 1099 forms received for all income including interest, dividends and rentals received and for any interest paid by you for mortgage, etc

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Copy of your year end 2021 mortgage statement for ALL PROPERTIES YOU OWN, including your primary residence, secondary residence, time share or business property.

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Copy of ALL leases for ALL properties you rent, including your primary residence and business residence.

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If DIVORCED or SEPARATED, a copy of your signed and recorded divorce decree and a complete copy of any property/marital settlements entered into between you and the child/s other parent. including any pending litigation regarding child support, support enforcement or child custody.

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Copy of driver's licenses of ALL responsible parties

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Copy of auto insurance CARD listing ALL cars

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Copy of your last three (3) months of ALL bank statements. INCLUDE EXPLANATION FOR ALL DEPOSITS.

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Copy of your last three (3) months of ALL credit card statements (not just page 1 of the bill) Do not submit blank or advertisement pages

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Copy of summer camp price list.

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Apply to Step Up For Students. Provide documentation that you applied. https://www.stepupforstudents.org

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Should be Empty:

	Child's name:	Grade:	School Name:	Total cost for school year:	Parent:	Financial Aid:	Loan:	Other-Explain

	Child's name:	Grade:	School Name:	Total cost for school year:	Parent:	Financial Aid	Loan:	Other (Explain):

	Child's Name:	Program:	Total Price of Activity:	Parent Amount Paid:	Financial Aid Received:	Loan:	Other (Explain):

	Child's Name:	Camp Name/Enrichment Program:	Location and Dates of Camp/Program:	Parent Amount Paid:	Financial Aid Received:	Loan:	Other (Explain):	Total Amount of Activity

	Child's Name:	Camp Name/Enrichment Program:	Location and Dates of Camp/Program:	Parent Amount Paid:	Financial Aid Received:	Loan:	Other (Explain):	Total Cost of Activity

Family Information

Employment Information

ACTIVITIES/TRAVEL/CELEBRATIONS

Monthly Income/Expense Analysis

General Financial Information

Parent #1 Signature

Parent #2 Signature

COMPLETED PACKET IS DUE NO LATER THAN

Existing Families: NO LATER then the same deadline date for submitting Re-Enrollment Agreements. New Families: One week from submitting the signed Enrollment & Tuition Agreement.

UPLOAD SECTION AND DOCUMENTATION

	Description:	Purchase Price:	Market Value:
Primary Residence:
Rental Property:
Rental Property:
Other Property:

	Location/Dates of Travel:	Family Members on Trip	Total Cost of Travel:	Self:	Family:	Other (Explain):	Loan:

	Child's Name:	Date of Service:	Name of Synagogue:	Location:	Cost:

	Name of Institution:	Type of Account:	Balance:	Name on Account	Last 4 Digits of Account #

	Name of Institution:	Type of Account:	Amount Owed:	Name on Account	Last 4 Digits of Account #