Friends School Scholarship Application
Due to Office by March 15, 2015
Part 1: Applicant and Family Information
Student Applicant Information
1. Last Name __________________________________________________
2. First Name _______________________________________ MI _______
3. Date of Birth ________________________________________________
4. Social Security Number _______________________________________
5. Class student will enter in August 2015 ___________________________
6. Indicate half or full day ________________ Extended day? ___________
7. Student lives with _____________________________________________
Complete next section only if multiple children will attend Friends in 2015-2016
1. Last Name __________________________________________________
2. First Name _______________________________________ MI _______
3. Date of Birth ________________________________________________
4. Social Security Number ________________________________________
5. Class student will enter in August 2015 ___________________________
6. Indicate half or full day ________________ Extended day? ___________
7. Student lives with _____________________________________________
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2.
3.
4.
5.
6.
7.
Last Name __________________________________________________
First Name ________________________________________ MI _______
Date of Birth ________________________________________________
Social Security Number ________________________________________
Class student will enter in August 2015 ___________________________
Indicate half or full day ________________ Extended day? ___________
Student lives with _____________________________________________
Parent or Guardian Information
Home address to which all correspondence will be mailed:
Number and street __________________________________________________
City/State/Zip Code _________________________________________________
Parent A:
Name ___________________________________________________ Age _____
Home Address _____________________________________________________
Occupation ______________________________________ Title _____________
Employer __________________________ Years with firm____Part or full time?
Parent B
Name ___________________________________________________ Age _____
Home Address _____________________________________________________
Occupation ______________________________________ Title _____________
Employer __________________________ Years with firm____Part or full time?
Complete this item only if applicant’s parents are separated, divorced or have never been married.
___ Divorced ___ Separated, no court action ___ Legally separated ___ Never Married
Year of divorce or separation ______ Is there a joint custody agreement? _________________
What is the agreement concerning school tuition? ______________________________________
Is this agreement in writing? ________
Parents’ Income and Expense Information
The information on this form is from a 2014 tax return that is _____ completed ______ estimated
(Attach a copy of your 2015 W-2’s, if estimated-proof of income is required)
How many children, including the applicant(s) are residing in your home and/or are receiving
support from you in 2015?_________________________________________________________
How many of the above children will be attending full time child care, tuition-charging
preschools, schools, or colleges in 2015-2016? ________________________________________
2014
Salaries and wages for Parent A
_________________
Salaries and wages for Parent B
_________________
Other Taxable income
_________________
Alimony received and/or estimated
_________________
Child Support received for all children _________________
Social Security benefits for whole family_________________
Other non-taxable income
_________________
Estimated 2015
_________________
_________________
_________________
_________________
_________________
_________________
_________________
Family Assets and Debts
Home (if owned) Year Purchased ________ Purchase Price _________________________
Present Market Value __________ Current monthly payment _______________________
Do you have a 2nd mortgage or equity loan on the home? ____________________________
If so, describe the purpose of the loan____________________________________________
Year of 2nd mortgage________ Year of equity loan _______ Payment ______________
All other real estate: Year purchased _______ Purchase Price ________________________
Present Market Value_____________ Current payment schedule______________________
If you do not own your home, and rent your family residence or live with extended family or
friends, please provide the total amount of annual rent you paid for 2014 and what you
estimate for 2015 ___________________________________________________________
Bank Accounts – total of parents’ checking and savings (interest bearing and non-interest bearing
accounts – as of the date you are completing this application):____________________________
Investments – net value (stocks, bonds, mutual funds, etc.). Do not include value of pensions,
retirement plans, IRA’s, SEP’s, or Keoghs. __________________________________________
List all family cars:
1. (make and year) ___________________________ own/lease/provided by company
2. (make and year) ___________________________ own/lease/provided by company
3. (make and year) ___________________________ own/lease/provided by company
Current total car debt ________________________
Annual Lease expense_____________
List all other vehicles, boats or recreational vehicles owned or leased:
______________________________________________________________________________
______________________________________________________________________________
Debts (including consumer debts):
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Amount of debts to be paid during 2015 _____________________________________________
Unusual Expenses and explanation (i.e. therapies)
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Family Expenses and Additional Information
How much are you requesting from Friends School for educational expenses for the 2015-2016
academic year for each student applicant? Do not leave blank!
Student A _____________
Student B ____________
Student C __________
Please complete the below information for all dependent children.
Current year (2014-2015)
Full name __________________________________________________ Age _______________
Name of current school_____________________Cost of school/child care__________________
Amount of care paid by parent____________ financial aid________ loan ___________________
Friends, relatives, or trust funds___________________ other sources ______________________
Full name ________________________________________________ Age _______________
Name of current school_____________________Cost of school/child care__________________
Amount of care paid by parent____________ financial aid________ loan ___________________
Friends, relatives, or trust funds___________________ other sources ______________________
Full name ________________________________________________ Age _______________
Name of current school_____________________Cost of school/child care__________________
Amount of care paid by parent____________ financial aid________ loan ___________________
Friends, relatives, or trust funds___________________ other sources ______________________
Next Year (2015-2016)
Full name ________________________________________________ Age _______________
Name of school___________________________Cost of school/child care__________________
Amount of care to be paid by parent____________ financial aid________ loan ______________
Friends, relatives, or trust funds___________________ other sources ______________________
Full name ________________________________________________ Age _______________
Name of school___________________________Cost of school/child care__________________
Amount of care to be paid by parent____________ financial aid________ loan ______________
Friends, relatives, or trust funds___________________ other sources ______________________
Full name ________________________________________________ Age _______________
Name of school___________________________Cost of school/child care__________________
Amount of care to be paid by parent____________ financial aid________ loan ______________
Friends, relatives, or trust funds___________________ other sources ______________________
Part II : Parents’ Certification and Authorization
We declare that the information reported on this form, to the best of our knowledge and belief is
true, correct, and complete. We agree to provide our latest income tax return to Friends School in
support of our application.
Parent A Signature _________________________________________ Date _______________
Home phone _______________________
Work Phone______________________
Parent B Signature _________________________________________ Date _______________
Home phone _______________________
Work Phone______________________
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Please use this space to explain your application and any unusual circumstances or
expenses. Why is it important to you that your child attend Friends School? Will your child
be able to attend without financial aid? Why is financial aid necessary? Discuss all
extenuating circumstances while being as brief as possible. Applications with this section
left blank will not be considered.