FINANCIAL ASSISTANCE APPLICATION
Hampstead Academy Financial Assistance Application Form
To be considered for Financial Aid, you must submit a new form for each year and attach a copy of all necessary documents listed below. Grants are determined and awarded each year by a financial review process that uses an objective set of guidelines to determine eligibility factors. Awards will be determined within a month of receiving an application form and all necessary documentation.
Documentation needed for this application:
1. Detailed copies of all pages and Schedules of the recent past year’s Federal Income Tax Return Form 1040, 1040A or 1040EZ 2. Copies of all current W-2 Wage and Tax Statement Forms. (Please make sure all documentation is copied on regular 8 1⁄2 x 11 paper). 3. Recent three months of payroll stubs if employed. 4. This application form filled out in its entirety, signed and dated by the Parent(s) or Guardian(s) listed in Sections A and B. IMPORTANT: If the above items do not accompany this application, your application will not be considered complete. ** ALL INFORMATION IS STRICTLY CONFIDENTIAL. ANY INFORMATION PROVIDED IS SIMPLY USED IN AN EFFORT TO FAIRLY DETERMINE WHAT AMOUNT IF ANY YOU QUALIFY FOR. ANY SHARING OF, OR RELEASE OF AID RECEIVED WITH OTHER FAMILIES WILL JEOPARDIZE FUTURE FINANCIAL ASSISTANCE.
Type of applicant
New
Renewal (Existing Financial Aid Recipient))
Student Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
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Is this a new or current student?
New
Current
List of Attended Schools
School Name
School Year
1
2
3
4
5
6
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Grade in the Fall 2026
Amount I/We feel I/We can pay toward tuition
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Applicant Information
The question that asks if there is a co-applicant must be checked YES if: 1. You are married and both parents of the student reside in the home. 2. You are a single parent, separated or divorced, both parents must complete their own application unless there is a court document stating one parent is not responsible for providing funds to the child.
Applicant's Name
First Name
Last Name
Marriage Status
Relationship to Student
Employment Status
Full Time
Part Time
Self-Employed
Retired
Disabled
Stay at Home
Unemployed
Student
Other
Employer
Occupation
Phone Number
Please enter a valid phone number.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Do you have a Co-Applicant?
Yes
No
Co-Applicant's Name
First Name
Last Name
Marriage Status
Relationship to Student
Employment Status
Full Time
Part Time
Self-Employed
Retired
Disabled
Stay at Home
Unemployed
Student
Other
Employer
Occupation
Phone Number
Please enter a valid phone number.
Email
example@example.com
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Parent Asset Information
Current value of cash, checking, savings.
Family Residence
Owned
Rented
Monthly payment (Include rental and insurance)
Estimated value of your home
Amount you owe for your home
Monthly home payment (Please include mortgage, insurance and property tax.
Do you own a second home?
Yes
No
Estimated value of your second home
Amount you owe for your second home
Monthly payment for your second home(Please include mortgage, insurance and property tax.
Taxable Income
Taxable Income
Actual Recent Year
($)
Estimate Upcoming Year
($)
Total adjusted gross income if Applicant and Co-Applicant filed a joint tax return.
Applicant's total taxable income from W-2 wages. (Total income for Applicant only if filed separately).
Co-Applicant's total taxable income from W-2 wages (Total for Co-Applicant only if filed separategly).
Other non-work taxable income from interest, dividends, alimony, unemployment, and non-business income.
Total tax paid as reported on your 1040, 1040A, or 1040EZ.
Medical/Dental expenses as reported on Schedule A line 1 on your IRS 1040 form.
Do you own a business?
Yes
No
Business Income Estimate 2025
Schedule C
Schedule E
Schedule F
What is your total estimated GROSS business taxable income?
What is your total NET business taxable income/loss (DO NOT LEAVE BLANK)?
Business Income Estimate continued
$
If your business pays your home rent or mortgage, what is the total total?
If your business pays for your automobile, what is the annual total?
If your business pays any portion of other expenses, list total amount.
If you own rental property: What was the total amount of Rental Income received?
Do you receive any non-taxable income? (choose that all apply)
Child support
tuition support from relatives/friends/employer
housing allowance
Worker's compensation
Temporary Assistance for Needy Families (TANF)
Others
No
Total non-taxable income (If apply)
Do you receive any other Tuition Financial Aid or Financial Assistance that's not included in your tax return?
Yes
No
How much other Tuition Financial Aid or Financial Assistance that you receive in the past year?
Other Annual Expenses
Total expense on vehicle (mortgage & insurance)
Total out-of-pocket medical expense if not paid by insurance
Total expense on vacation this past year
Is the Student attending a private school for this current school year?
Yes
No
Total amount of tuition fee contracted for current school year
Do you have more than one child that's attending a private school/day care?
Yes
No
Total amount of tuition fee contracted for current school year for your other child(ren)
Total expense on camps, after-school care, tutoring, enrichment programs and special programs? (Please include all fees if you have more than one child)
Change of Income/Circumstances
Do you anticipate a decrease in your annual income?
Yes
No
Applicant's total current annual income
Applicant's estimated total annual income in the upcoming year?
Co-Applicant's total current annual income?
Co-Applicant's estimated total annual income in the upcoming year?
Unusual Circumstances (check all the apply)
Loss of job
Recent divorce or seperation
Change in family living status
Change in work status
Bankruptcy
College expenses
Income reduction
Illness or injury
Death in the family
Shared custody
High debt
Child support reduction
Medical expenses
Shared tuition
Other (explain in next section)
Other unusual circumstances (explain here)
Please provide a reason why are you applying for financial assistance.
Please indicate below why we should choose you or grant you financial assistance.
Applicant Signature
Date Signed
-
Month
-
Day
Year
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Federal Income Tax Return Form 1040, 1040A or 1040E, and W-2 FORMS
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If you have not yet filed a current IRS FORM 1040. Then your most recent Form 1040, 1040A or 1040E. And most recent W-2 FORMS
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Recent past three month's paysubs. (If you are employed).
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