Tuition Assistance Form

Shepherd of the Hills Catholic School

W1562 County Road B

Eden, Wisconsin 53019

(920) 477-3551
Tuition Assistance Application
Parent/Guardian Information
Father/Guardian

First NameLast Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Religion
Parish of Membership
Occupation
Annual Income
Mother/Guardian

First NameLast Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Religion
Parish of Membership
Occupation
Annual Income
Marital Status of Parents Listed Above:

SingleMarriedSeparated/DivorcedOther
Please answer the following if you responded single, separated/divorced, or if both parents are not responsible for payment of tuition and fees.
Who is responsible for payment of tuition?
Who will claim student(s) as a tax dependent?
Family/Student Information
Number of Adults that reside in the household:
Number of Children that reside in the household:
List children who will be students at Shepherd of the Hills in the coming school year:
Tuition Assistance
Do your children qualify for Free/Reduced Lunch?

YesNo
Do you participate in the Scrip program on a regular basis?

YesNo
If you do not participate in the Scrip program, please list your reason:
How much tuition are you able to pay monthly?
Please list the reason(s) for your request of tuition assistance. (i.e. change in income status, family status, health reasons, etc.)
Name of Person Completing Tuition Assistance Application
I hereby agree that the information given is true, accurate, and complete as of the date of this application submission.

YES
Should be Empty:

Shepherd of the Hills Catholic School

Tuition Assistance Application

Parent/Guardian Information

Family/Student Information

Tuition Assistance