25-26 K-12 Tuition Form

Parent or Guardian's Full Name *

First NameMiddle NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Contact Number*

Area CodePhone Number

E-mail*

Eastgate MemberNon-member

Enter your tithe paying code

Please request this code form finance@eastgateupc.org

Number of students you have attending Eastgate Academy:*

Please list the names and grades of your students below (e.g., Name - Grade):*

How would you like to pay for tuition:*

AnnualBi annualMonthly

Amount Due: $4,500

Amount Due: $8,500

Amount Due: $12,000

Amount Due: $15,500

Amount Due: $2,250 (next payment due January 17th)

Amount Due: $4,250 (next payment due January 17th)

Amount Due: $6,000 (next payment due January 17th)

Amount Due: $7,750 (next payment due January 17th)

Amount Due: $450 / month

Amount Due: $850 / month

Amount Due: $1200 / month

Amount Due: $1550 / month

Amount Due: $3000

Amount Due: $5,500

Amount Due: $7,500

Amount Due: $9,500

Amount Due: $1,500 (next payment due January 17th)

Amount Due: $2,750 (next payment due January 17th)

Amount Due: $3,750 (next payment due January 17th)

Amount Due: $4,750 (next payment due January 17th)

Amount Due: $300 / month

Amount Due: $550 / month

Amount Due: $750/ month

Amount Due: $950 / month

Tuition Subscription Payment

Enter amount from above

MONTHLY PAYMENTS WILL BE AUTOMATICALLY WITHDRAWN ON THE 17TH DAY OF EACH MONTH.

If your full monthly payment is not received by the 17th of the month there will be a $25 late fee added monthly until the account is up to date.

Annual Book Fees*

Preschool $130 per studentKindergarten $195 per student1st - 5th $360 per student6th - 8th $320 per student9th - 11th $360 per student + electives12th $200 per student + electivesElectives TBD

How would you like to pay book fees? *

Annual Art Fees*

1 student $122 students $243 students $364 students $485 students $60

If you prefer to opt out of convention fee payments below, you will be required to fundraise and pay the full amount before convention.

Annual High School Convention Fees (subject to increase)

1 student $2502 students $5003 students $7504 students $1000

How would you like to pay convention fees?

Additional Fees Total

Enter total additional fees selected above

I authorize the tuition payment to be automatically drafted from my account on a monthly basis beginning in August until my balance has been paid in full.

Please do not alter the $1.00 USD box. This section is strictly for verifying your bank account. If you change the amount, it will be drafted from your account immediately after verification.

Families who wish to pay book fees, art fees, or convention fees in full will have the opportunity to do so at Open House or with your first month's tuition subscription.

Payment Subscription Amount

My Products*

USDDO NOT ALTER THIS BOX

Verify Your Account
Stripe verifies your account by depositing two small amounts into your bank account.Enter these two deposits into the text boxes below, and click on the Verify button
First Deposit:
Second Deposit:

Bank Account
Email
Routing Number	Account Number
Name On Account	Bank Account Type

Parent Signature*

K-12 Tuition Form

Tuition Information

Additional Fees