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 tax 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. Please note the required tax year documentation. 1. Detailed copies of all pages and Schedules of last 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. 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 scholarship)
Student Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
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Gender
Male
Female
Other
Grade Level
School Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
List of Attended Schools
School Name
School Year
1
2
3
4
5
6
Grade in the Fall 2025
Amount I/We feel I/We can pay toward tuition
Type a question
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Parent Information
If parents are divorced or living in separate households, each parent must submit a completed application with all required documents. If not married, living with a partner, please include their information as Parent B.
Father's Name
First Name
Last Name
Father's occupation
Father's employer
If not employed full-time, please explain why
Father's Phone Number
Please enter a valid phone number.
Mother's Name
First Name
Last Name
Mother's occupation
Mother's employer
If not employed full-time, please explain why
Mother's Phone Number
Please enter a valid phone number.
Legal Guardian Name
First Name
Last Name
Legal guardian's occupation
Legal guardian's employer
If not employed full-time, please explain why
Legal Guardian Phone Number
Please enter a valid phone number.
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Please provide a reason why are you applying for financial assistance.
Please indicate below why we should choose you or grant you financial assistance.
Parent Asset Information
Current value of cash, checking, savings.
Family Residence
Owned
Rented
Monthly house payment
House: year purchased
House: purchase price
House: Present Value
Other real estate investments
Taxable Income
Taxable Income
Actual 2024
($)
Estimate 2025
($)
Total number of exemptions claimed on Federal Income Tax form.
Parent/Guardian A total taxable income from
W-2 wages. (Total income for Parent A only).
Parent/Guardian B total taxable income from W-2 wages (Total for Parent B only).
Net business income from self-employment, farm, rentals, and other businesses.
Other non-work taxable income from interest, dividends, alimony, unemployment, and non-business income.
Allowable "Adjustments to Income" as reported on your IRS 1040, 1040A, or 1040EZ.
Total "Adjusted Gross Income" as reported on your IRS 1040, 1040A, or 1040EZ.
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.
Business Income Estimate (2025 totals)
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?
Unusual Circumstances (check all the apply)
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)
Past Tuition Expenses
Number of dependent children who attended a tuition charging school: daycare, Pre-K, elementary school, secondary school, or college.
Past Tuition Expenses
Dependent Last Name
Dependent First Name
Age
Current Grade Entering
Received Assistance (Y/N)
Tuition Charged Yearly Per Student
1.
2.
3.
4.
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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