Name of Child *

First Name

Last Name

Male or Female? *

Male

Female

Date of Birth *

MM

DD

YYYY

Father's or Guardian's Name:

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Home or Cell?

Home

Cell

Work Phone

(###)

###

####

Work Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Mother's or Guardian's Name:

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Home or Cell?

Home

Cell

Work Phone

(###)

###

####

Work Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Financial Information: Families who wish to apply for tuition assistance MUST complete the application and submit documentation of Combined Gross Household Income.

I will be applying for tuition assistance

I will NOT be applying for tuition assistance

Date

MM

DD

YYYY