2023-24 Financial Assistance Application

Financial Assistance Application
***LATE APPLICATIONS - Applications submitted after 4 p.m. on 2/28/2023 will be reviewed after 3/24/2023 and subject to the availability of funds.
Financial Assistance Application Checklist

Please review the Financial Assistance Application Checklist by clicking on the blue text below.
Scroll down to read both pages of the Financial Assistance Application Checklist below.
Prior to filling out this application please make sure you have the following:
a) 2021 completed individual tax return (PDF format)

*If your 2022 tax returns are completed please upload those instead of the 2021 tax returns (PDF format)

b) 2022 W-2 forms for all guardian(s) (PDF format)
c) Debit or credit card for $35 Financial Assistance Application processing fee
***The above documents are required to submit this form. This form must be completed in one sitting. Incomplete applications cannot be processed.***

Due Dates:
The completed application and supporting documents for current families are due no later than 4 p.m. on February 28, 2023. New applicant(s) to HBHA are required to submit all documents by communicated deadlines.

Note: Fields below may have directions or instructions to the right when you hover over it.
Amount of Financial Assistance Request

How much are you requesting in Financial Assistance for all student(s) attending HBHA during 2023-24 academic year?
*
(Do not enter how much you want to pay for the 2022-23 school year.)

Primary Contact Information

Primary person HBHA will contact during the financial assistance process.
Primary Contact*

First NameLast Name
Email*
example@example.com
Phone Number*

Area CodePhone Number
Relationship to student (s)*
Contact and Demographic Information

Parent/Guardian(s) contact information
Number of student(s) that you are applying for Financial Assistance for?*
Name of student(s) and grade(s)*
Marital Status of Parent*

MarriedDivorcedSeparatedWidowedSingle
Name of Spouse/Partner

First NameLast Name
Mailing Address*

Street Address

Street Address Line 2

CityState

Zip Code
Name(s) and age(s) of other dependent children that the household supports excluding those listed above (birth through college)(Enter N/A if this does not apply)*
Name(s) of other dependent(s) living in the household and relationship to student. I.E. Grandparents or other relatives. (Enter N/A if this does not apply)*

Jewish Community Programs/Services
Have you or any member of your family received an adjusted fee for any program, membership, or service within the Jewish Community (e.g. JCC after school care)?*

YesNo
If yes, list program(s), date, full fee requested and amount you paid below.

Community Involvement
Please describe your family's involvement in the Kansas City Jewish community or Kansas City community, in general. *
Please describe your family's involvement in the HBHA community. List activities/efforts - for example, do you volunteer at HBHA, serve on the Board of Directors, are you a member of PTO, been a room parent, etc.*

Employment Information
Please indicate the anticipated amount of gross earnings your household will receive during the 2023-24 school year(if not applicable enter "0.00"):
Occupation of the Head of Household (Job Title)*
Gross Income Earned during 2022*
Enter gross income earned during 2021
Projected Gross Income for 2023*
Enter gross income that you anticipate earning in 2022
Are you self-employed?*

YesNo
Business Name*
Business Phone Number*

Area CodePhone Number
Business Address*

Street Address

Street Address Line 2

CityState

Zip Code
Occupation of the Spouse/Partner (Job Title)
Gross Income Earned during 2022
Enter gross income earned during 2021
Projected Gross Income for 2023
Enter gross income you anticipate earning during 2022
Are you self-employed?

YesNo
Business Name
Business Phone Number

Area CodePhone Number
Business Address

Street Address

Street Address Line 2

CityState

Zip Code

Additional Financial Information

2023-24 School Year Income
Government Assistance
SSI / Disability
Distribution from Trust Funds
529 Plan Distribution
Interest / Dividend Income
Other Income (Explain in Below)
If other income, explain:
If you are divorced or separated, please answer the following questions (Enter "0.00" if this does not apply to you):
Child Support
Maintenance / Alimony
Other individual(s) who regularly help pay for family expenses:
Relationship to Student(s)
Annual Amount Given
Relationship to Student(s)
Annual Amount Given
Explain any short term circumstances that are affecting your finances and include how long this situation might last (i.e. divorce, loss of job, short term medical problems). If not applicable, input N/A.*
Explain any long term circumstances (any situation that may extend to 3 years or longer) that you would like the financial assistance committee to consider during their review process. If not applicable, input N/A.*

Tax Information
Enter Total Income from 2021 or 2022 Tax Return (Line 7b on 1040 Form)*
For Individual / Joint Tax Filers
Attach 2021 Tax Return*

Browse Files

Cancelof
Attach 2022 Tax Return (Married Couples Filing Separately)

Browse Files

Cancelof
Attach 2022 Tax Return (If Completed/Filed)

Browse Files

Cancelof
2022 W-2 Form or Copy of Last Paycheck Stub

Browse Files

Cancelof
Additional 2022 W-2 Forms

Browse Files

Cancelof
Self-Employed Attach Most Recent Financials

Browse Files

Cancelof

Household Expenditures

What amounts do you anticipate paying for the following items during the 2023-24 school year: (Enter "0.00" if you do not have any expenses for that category, enter "N/A" in other explanation if it is not applicable)
Rent or Mortgage
Transportation (Vehicle Payments)
Maintenance / Child Support
Childcare Expenses
College Tuition & Fees
Elderly Care
Other (explain below)
If other, list below

Statement of Unusual or Temporary Circumstances
Is your family applying for financial assistance due to an unusual or temporary circumstance? For instance are there unusual medical expenses or loss of income. Use this as an opportunity to explain to the financial assistance committee why you need financial assistance. An explanation of need will assist the committee in granting financial assistance awards.*

Financial Assistance Pilot Program

Only families with current 9th & 10th-grade students are eligible to participate.
HBHA is considering new financial assistance models to enhance our partnership with our families, and provide optimum support for our students and our school. We are taking a careful, measured approach to rolling out a new financial assistance system to ensure it will best meet the needs of our school community. Click here to read additional information about this pilot program.
Type a question

Yes, I have a current 9th or 10th-grade student, and I wish to participate in the multi-year pilot program.

I/We declare that the information contained in this form, to the best of my knowledge and belief, is true, correct, and complete. I/We understand that funds available for assistance are limited and that the amount of assistance, if any, will be based on financial need and available funds. I/We also understand that I/We will be required to make electronic payments through FACTs, if I/We accept the Financial Assistance Award.*

Yes, I/We have read, understand, and accept the above statement.
Name of Guardian (Electronic Signature)*

First NameLast Name
Date*

MonthDayYear
Date
Name of Guardian (Electronic Signature)

First NameLast Name
Date

MonthDayYear
Date
I agree that the electronic signature appearing on this agreement are the same as handwritten signatures for the purposes of validity, enforceability, and admissibility.

Clear
Financial Assistance Application Fee

Financial Assistance Application Fee*

Application Fee$35.00

Total $0.00

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year
Billing Address
Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Should be Empty:

Financial Assistance Application

Financial Assistance Application Checklist

Amount of Financial Assistance Request

Primary Contact Information

Contact and Demographic Information

Jewish Community Programs/Services

Community Involvement

Employment Information

Additional Financial Information

Tax Information

Household Expenditures

Statement of Unusual or Temporary Circumstances

Financial Assistance Pilot Program

Financial Assistance Application Fee