Tuition Assistance Form

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PLEASE NOTE: When filling out this form, please have the following information available: • tax returns from this year and last year, • names of banks and investment institutions, • list of assets and liabilities, • list of expenses, • current budget, • family contact info. ADDITIONAL NOTE: A complete copy of your two most recent Federal Income Tax Returns with all schedules must be submitted with this application in order to be considered for Tuition Assistance. (Tuition Assistance Applications are reviewed in the strictest of confidentiality.)

STUDENT’S NAME

Last Name*

First Name*

Hebrew Name*

Address*

City*

State*

Zip*

Phone*

Entering Grade*

9th Grade

9th Grade
10th Grade
11th Grade
12th Grade

In Academic Year*

SECTION A - Employment Information

Name (Parent 1)*

Home Address*

Employer Name*

Address*

Nature of Business*

Position Held*

Years with Firm*

Self-Employed?*

Yes

Number of employees*

Gross Annual Revenue*

Are you the Sole Owner of Your Business?*

Yes

Number of partners*

Name (Parent 2)*

Home Address*

Employer Name*

Address*

Nature of Business*

Position Held*

Years with Firm*

Self-Employed?*

Yes

Number of employees*

Gross annual revenue*

Sole owner?*

Yes

Number of partners*

SECTION B - Family Information

Paternal Grandparent's Names*

Address*

Email*

Phone

Maternal Grandparent's Names*

Address*

Email*

Phone*

Applicant's Family Synagogue Name*

Parent/Student Synagogue

Applicant's Family Synagogue Address*

Name of Rabbi*

Phone*

List all dependent children. For Families with more than 2 children, please fill out the box titled "Other Dependent Information with the following information for all children: name, age, grade, Last Year’s School/Child Care Cost , Last year's actual amount parent pays, Current Year's School/child care cost, and current year's amount parent pays.

Number of Dependents

1

Child Applying to FTI Name #1*

Age*

Grade*

Last Year’s School/Child Care Cost*

Last Year’s Actual Amount Parent Pays ^*

Current Year’s School/Child Care Cost*

Current Year’s Actual Amount Parent Pays ^*

Note: Actual Amount = School Tuition + Fees + Room and Board (where applicable) – Financial Aid

Child Name #2

Age

Grade

Last Year’s School/Child Care Cost

Last Year’s Actual Amount Parent Pays ^

Current Year’s School/Child Care Cost

Current Year’s Amount Parent Pays ^

Other Dependent Information

SECTION C – Financial Information

Gross Income – parent 1: Previous Year*

Estimated For This Year*

Gross Income – parent 2: Previous Year*

Estimated For This Year*

Dividends and/or Interest Income: Previous Year*

Estimated For This Year*

Alimony Income: Previous Year*

Estimated For This Year*

Net Business Profit (or Loss) – explain separately: Previous Year*

Estimated For This Year*

Social Security Benefits – anyone in the family: Previous Year*

Estimated For This Year*

All Other Income: Previous Year*

(including rental income, investment income, parsonage, etc.

Estimated For This Year*

Total Income: Previous Year*

Estimated For This Year*

Total Income Tax Paid: Previous Year*

Estimated For This Year*

If you expect any increase or decrease during the upcoming school year, please explain.*

SECTION D – Assets & Liabilities

ASSETS

Checking Account-Financial Institution*

Current Balance*

Average Balance*

Savings Account- Financial Institution*

Current Balance*

Average Balance*

CDs- Financial Institution

Current Balance*

Average Balance*

Insurance- Financial Institution*

Current Balance*

Average Balance*

Stocks/Bonds- Financial Institution*

Current Balance*

Average Balance*

Other Assets- Financial Institution*

Current Balance*

Average Balance*

Total Assets- Financial Institution*

Current Balance*

Average Balance*

Other Assets Explained (from above)*

LIABILITIES Write Zero if it is not applicable

Real Estate- Rent Monthly Payment*

Purchase Date*

Purchase Price*

Unpaid Balance*

Present Market Value*

Real Estate- Own HomeMonthly Payment*

Purchase/Start Date*

Purchase Price*

Unpaid Balance*

Present Market Value*

Other Real Estate- Monthly Payment*

Purchase/Start Date*

Purchase Price*

Unpaid Balance*

Present Market Value*

Family Vehicle 1- Make*

Year*

Monthly Payments*

Faily Vehicle 2- Make

Year

Monthly Payments

Family Vehicle 3- Make

Year

Monthly Payments

SECTION E – Supplemental Information

Summer Camp Last Summer- Name of Camp(s)*

Total Children Attending*

Cost of Attendance*

Total Fees Due or Paid*

Total Scholarship*

Summer Camp This Coming Summer- Name of Camp(s)*

Total Children Attending*

Cost of Attendance*

Total Fees Due or Paid*

Total Scholarship*

How are family vacations/Yomim Tovim spent?*

Have you done any home improvements over the past five years? If so, please specify.*

SECTION F – Request for Tuition Reduction

2020-2021 Tuition and Fee Schedule
Tuition* ..............................................................................$18,900
Registration Fee ..............................................................................$500
Give-or-Get .....................................................................................$1,000
Building Fund** ................................................................................$750
Hot Lunch/Mishmar*** .....................................................................$800
Room & Board (if applicable)...........................................................$6,000
Transportation .............................. $1,000-$2,250 Depending on Location
*Tuition assistance scholarships are available to approved families. **One Building Fund and Give-or-Get fee per family. *** Included in Room and Board if student is boarding.

How much financial assistance are you requesting (stated as a reduction from the full tuition amount)?*

$2000

$4000

$6000

$8000

Other

Please Note: financial assistance only applies to tuition costs, not to any other fees, such as registration, give-or-get, building fund, or room & board.)

If you chose "Other" from the previous question, how much tuition assistance are you seeking (stated as a reduction from the full tuition amount)?

Please explain any special circumstances that are not explained elsewhere in this application.*

Parents receiving scholarships are expected to help support FTI’s scholarship fund, i.e. helping raise money for our CHARIDY fundraiser, help obtain matching funds from your employer, providing professional services (where applicable), etc. Please describe any particular ways you can be helpful in this regard.*

I attest that my responses written above are true and accurate.

Name*

Date*

Tuition Assistance Form

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