PART TWO Financial Questionnaire

Financial Questionnaire

for Bursary Applications &/or temporary financial assistance. Details provided on this form are password protected and sent directly to the College Business Manager.
Account No
Status*

ExistingNew
Applicant Details

Parent / Guardian 1
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Occupation*
Employer*
Home Phone Number
Please enter a valid phone number.
Mobile Number*
Please enter a valid phone number.
Email*
example@example.com
Spouse

Parent / Guardian 2
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Occupation
Employer
Home Phone Number
Please enter a valid phone number.
Mobile Phone Number
Please enter a valid phone number.

Children Details
Details of school aged children living at home*
Child's full name, grade/class, current school attending

Financial Request
Reason why financial assistance required?*
If a "Bursary" is not available, would you be prepared to provide some form of security to the school that covers the outstanding debt?*

YesNo
How long have you been receiving financial assistance from THAC*
For how long do you expect to require financial assistance from the school*
Self Assessment - Please indicate the contribution you can make towards your child/children's education per term, excluding compulsories ("Sundry charges" for excursions, etc.*
Per term

Support Documents
Please note the following information and requirements:
1. Approval of fee assistance is based on Tuition fees only. Applications will be required at least once a year.
2. Students are expected to comply with school rules and regulations, including those relating to behaviour and dress, and maintain application to study.
3. Salary earner - Income tax return and assessments and most recent pay advice
4. Social Security - Copy of weekly/fortnightly entitlement from the Government Department
5. Name of insurer, solicitor and advice of progress of claim to date
6. Evidence of rental/mortgage payment required
7. Business - full set of financial statements from an accountant.
Income Tax Assessment*

Applicant and Spouse
Cancelof
Pay Advice*

Applicant and Spouse
Cancelof
Social Security Advice

Applicant and Spouse
Cancelof
Name of insurer, solicitor and advice of progress of claim to date

Applicant and Spouse
Cancelof
Evidence of rental/mortgage payment required

Applicant and Spouse
Cancelof
Business – full set of financial statements from accountant

Applicant and Spouse
Cancelof
Maintenance

Applicant and Spouse
Cancelof

Monthly income and expenditure

Note: if documentation is not included this questionnaire will be returned

Monthly income (After Tax)*

	Total $ amount after tax unless stated
1. Applicant Income
A. Applicants Income (Before Tax)
2. Spouse Income
B. Spouses Income (Before Tax)
3. Business Income
4. Other (show details)
5. Rental Income
6. Interest
7. Dividends
8. Other (specify)
9. Pension (s)
10. Social Security Payments
11. Maintenance (Family Law)
12. Other (specify)
13. Other (specify)

Monthly Expenditure (A) Living Expenses*

	$
Board/Rent/Home/Repayments / Mortgage
Living (food clothing and personal)
Other Finance Commitments (e.g. MV)
Other
Bankcard / Credit Cards
Life Assurance / Superannuation

Monthly Expenditure (B) Motor Vehicle Expenses*

	$
Comprehensive Insurance
Registration / Third Party etc.
Tyres/ Service / Repairs / Petrol

Monthly Expenditure (B) Home Expenses*

Assets

Liabilities

Declaration
I/We hereby declare that all information given on these forms is true and accurate to the best of my/our knowledge. I/We have also read and agree to all conditions outlined in this application, either directly or impliedly. I/We also understand that should it be proved that I/we have intentionally misled The Hamilton and Alexandra College by giving false information, I/we will be liable for payment of full fees retrospectively from the start of the resulting discounted tuition fees. Any material change in circumstances will be advised promptly to the School. The School may verify the relevant information provided. In the case where more than one person is responsible for the child/children, both parties must sign. For a sole parent or single guardian, one signature is sufficient.
Signature of Applicant / Guardian

Clear
Signature of Spouse Guardian

Clear
Date

MonthDayYear
Date
Date

MonthDayYear
Date
Name of Applicant / Guardian
Name of Spouse / Guardian
I confirm that the information provided in thisdocument is correct’
Should be Empty:

Financial Questionnaire