• Day School Affordability Grant Application

  • Please complete the form below to be considered for the Day School Affordabilty Grant. You will need a copy of your most recent 1040 Tax form and W2.

    It should take about 10 minutes.

    Divorced parents may fill out forms individually, and submit separately. The determination process will begin once both forms are received.

    All information submitted through this form is kept strictly confidential. It is visible only to the CFO of Samis Foundation and the Business Manager of the school(s) you select. No member of the Admissions committee will see this information. 

    Grant determinations will be made within four weeks of receiving a complete application.

    Due Wednesday, May 4, 2022

  • 1. Family Information

    Divorced, single, separated or never married parents may submit separately.
  • 2. School Attendance Information

    Please fill out this section for all children attending schools in 2022-2023 that require tuition, including all early childhood programs, independent schools, and college, even if they are not Jewish schools.
  • Child 1

    • Additional children  
    • Child 2

    • Child 3

    • Child 4

    • Child 5

    • Child 6

    • Child 7

    • Child 8

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    • 3. Income Information

      If married filing joint, divorced, single, separated or never married use the first column for 1 tax return. If married filing separate, use both columns for 2 tax returns.
    • Enter the amounts from your most recent tax return. Please do not use dollar signs or commas.

    • Parent 1/ P1 (or married filing joint) is first column.

       

    • Parent 2/ P2 (or married filing separate) is second column.

       

    • Enter the following AMOUNTS RECEIVED during the year of tax return submitted, but which do not appear on the tax return.

       

    • Enter the following AMOUNTS PAID during the year of the tax return submitted, but which do not appear on the tax return. 

    • Retirement plan contributions for the year of the tax return submitted. This may be found on the year-end pay stub and/or listed on the W2.

    • Additional retirement plan information for the year of the tax return submitted. These may be found on the year-end pay stub and/or listed on the W2.

    • This information is listed on your tax return. Please use the number on the tax return for the year submitted:

    • 4. Copy of your tax return and W2s

      Please remove passwords to documents prior to submitting. 1. Open the PDF in Acrobat Pro on Windows or Mac. 2. Choose Tools › Encrypt › Remove Security. 3. If the document has a Document Open password, click OK to remove it. 4. If the document has a permissions password, type the correct password in the Enter Password box and then click OK.
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    • 5. Applicant's E-Signature

      Thank you for your commitment to your child's Jewish future.
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