Application for Financial Assistance

Application for Financial Assistance
Personal Information

Please fill out this section completely.
Name

First NameLast Name
Date of Birth

DayMonthYear
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Country of Citizenship
Are you a member of Eastgate Church?

YesNo
Financial Assistance is currently only available to members of Eastgate Church.
Have you applied for financial aid from Eastgate Academy before?

YesNo
If you have, how much did you receive?
Student Information

Please fill out this section completely.
Student Name

First NameLast Name
Date of Birth

DayMonthYear
What grade will the student be attending?
General Financial Information

Fill out the corresponding sections that best describes your situation.
What is the approximate total of your monthly expenses (rent, food, transportation, etc.)?
How many immediate family members do you have? (spouse or children)
Do you receive income form any other source(s), (support, sponsorship, etc.)?

YesNo
What is the total of support/other income you receive per month?
Do you have a job?

YesNo
If yes,
Monthly financial assistance amount being requested?
USD
Reasons Eastgate Academy is important
How Eastgate Academy has benefitted my child
Other Circumstances

In the Space below please describe any other reasons or circumstances (past, present, or future) that you feel increase your qualification and/or need for financial assistance at Eastgate Academy (e.g., family circumstances, academic standing, ministry or other responsibilities; etc.).
Reason or Circumstance:
Conditions Upon Acceptance
If your application is accepted, understand that the work-study or class assistant position, scholarship, or tuition discount offered to you is conditional and that to continue receving the same your Student must:

a. Abide by all Eastgate Academy policies.

b. Live in compliance with Eastgate Church Standards.

c. Fulfill all class or work-study obligations, where applicable.
Signatures
I affirm that the information provided is true and accurate according to my knowledge.
Date

DayMonthYear
Guardian/Parent Signature

Clear
Upon submission you agree that you understand the information on this application will be used to help determine your eligibility to receive Financial Assistance through our Partners in Education (P.I.E) Program for Eastgate Academy and will not be released to anyone other than necessary personnel.
Should be Empty:

Application for Financial Assistance

Personal Information

Student Information

General Financial Information

Other Circumstances

Conditions Upon Acceptance

Signatures