DUE DATES: New Student- Friday, January 29, 2016 Returning Student- March 15, 2016

ST. GENEVIEVE HIGH SCHOOL Financial Assistance Packet

2016-2017

STUDENT LAST NAME___________________________ FIRST NAME_____________________ 16-17 GRADE_____ PARENT/GUARDIAN NAME(s):_________________________________________________________________________________ CONTACT PHONE NUMBERS: _____________________________________________________________ EMAIL ADDRESS: _______________________________________________________________________ Dear Parents and Guardians,

I would like to take this opportunity to thank you on behalf of St. Genevieve High School faculty and staff for the opportunity to serve your family. Below is the checklist of all the items necessary to process your financial aid application. I would appreciate if you would take your time to fill out the application thoroughly. If you have any questions or concerns please send a note with your application and I will be more than happy to contact you. Zara Akopyan Tuition Advisor (818) 894-6417 x104 email: zara@sgps.org

APPLICATION CHECKLIST PLEASE INCLUDE COPIES OF ALL NECESSARY DOCUMENTS BEFORE

SUBMITTING YOUR PACKET TO THE MAIN OFFICE.

o $45 Financial Aid Application Fee o Completed and signed Tuition Assistance Application o Budget Report (if applying for Principal’s Grant) o Student Application o Proof of Income (Single-Member households need to provide legal documentation from the court) o Copies of Bank Statements for the past 3 months o Copies of Car Registration Forms for all cars

SERVICE HOUR REQUESTS □ I would like to participate in the Bake Sales (limited positions available). Saturday & Sunday events □ I would like to participate in Sports Events (limited positions available). Evening events □ I would like to participate in cooking at home. □ I would like to donate funds. For every $ 8.00 donated you will earn 1 hour of service. □ I would like to donate goods. For every $8.00 spent will earn you 1 hour of service. □ I would like to raise money toward service hours □ I am available during the day for office help.

Mr. Jose Mejia is the coordinator for all service hours. He can be reached at (818) 894-6417 x109 or jmejia@sgps.org.

We would like to hear from parents who have any special ideas or needs.

School Office Use Only New Student ( )

Due date: 01/29/2016 Returning Student ( )

Due date: 03/15/2016 $45 Fee Paid:

Family Income Guidelines

2016-2017

An applicant from a household with total incomes at or below the following levels

is financially eligible for St. Genevieve High School Financial Assistance.

Household Size*

Spirit Grant $1,500

Annual Income

Principal’s Grant More than $1,500

Annual Income

2

$44,200

$33,000

3

$54,500

$36,280

4

$64,800

$43,560

5

$75,100

$50,840

6

$85,400

$58,120

7

$95,700

$65,400

8

$106,000

$72,680

*Household size is determined by using information on your tax returns.

STUDENT APPLICATION 2016-2017

Financial Assistance

FOR RETURNING STUDENTS

1. Did you receive financial aid from St. Genevieve High School last year? YES_______ NO_______ If yes, how much did you receive? $_________________

2. Did you attend our high school Open House on Saturday, November 15? YES_______ NO_______ (if the answer is no, please explain why not) ______________________________________________________________________________ ______________________________________________________________________________

3. Thinking back on your previous year(s) at St. Genevieve. Is there one experience that had a

particular impact on your life? Please explain. ________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________

FOR ALL STUDENTS

4. What extracurricular activities are you currently involved in? ________________________________________________________________________________________________________________________________________________________________________________________________________________________

5. Please list one teacher that would be willing to act as a reference for you: ________________________________________________________________________

6. Tell us about your contribution to your school community last year:

________________________________________________________________________ ________________________________________________________________________

7. Please list 5 goals you would like to accomplish in the 2016-2017 school year.

x __________________________________________________________________ x __________________________________________________________________ x __________________________________________________________________ x __________________________________________________________________ x __________________________________________________________________

8. We appreciate if you could include a thank you letter with your application. Please write the letter

on a separate sheet of paper and attach it to this form. By signing this application you agree that you will comply with the following terms:

x I will maintain at least a 2.0 GPA at the end of each semester. x I agree to participate in one fundraising activity during the school year. x I agree to perform my Christian service hours. x I agree to attend all Night Schools, Special Events, and OPEN HOUSE. x I agree to attend and support my school’s sports teams and performing arts groups.

Signature of Student: _______________________________________ Date: _____________

Information submitted on this application will remain confidential.

STUDENT INFORMATION  

First Name:  Middle Name Initial: 

  Last Name:  

Street Address: 

City:  State:          CA  ZIP:  Student Birth Date: ______/______/__________ 

Sex:   Male     Female  Grade  entering in Fall 2016:     School Currently Attending: 

Type of School:    

 Catholic       Public  

 Charter    Home School 

 Other ______________ 

Ethnic Background (Optional):  

 Afro American     Armenian     Asian: _____________(Nationality)      Caucasian/White     Filipino     Hispanic/Latino            

 Pacific Islander     Middle Eastern     Multiple Ethnicities   Native American: ______________(Please List Tribe)   Declined to State    

Religious Background (Optional): 

 

 Roman Catholic     Jewish     Muslim     Mormon     Southern Baptist     Sikh     Hindu     Buddhist       

 Other Christian: _________________     Other: _______________________________     Declined to State     No Religious Affiliation  

HOUSEHOLD INFORMATION Parent/Guardian A (Parent or Guardian legally responsible for Student) First Name: Last Name: Marital Status:  

 

 Single        Divorced   Widowed 

 Married    Separated  

 Domestic Partnership 

Relationship w/ Student:      Mother    Father    Grandparent   Step‐Parent     Guardian     Foster Parent     Other _____________________ 

CONTACT INFORMATION   Email:    

Home Phone: (_____) _______‐ ____________  Cell Phone: (_____) _______‐ _____________  

Work Phone: (_____) _______‐ ____________ Employment Status:    

 Employed       Self‐Employed  

 Homemaker   Unemployed    

 Retired            Disabled    

 Full‐Time Student 

Occupation:  Employer: 

If self‐employed, type of business:    Name of Business:   

Parent/Guardian B (Parent or Guardian residing with Parent/Guardian B) First Name: Last Name: Relationship to Parent/Guardian A:   

 

 Spouse        Relative  

 Ex‐Spouse    Other  

 Domestic Partner 

Relationship w/ Student:      Mother    Father    Grandparent   Step‐Parent     Guardian     Foster Parent     Other _____________________ 

CONTACT INFORMATION   Email:    

Home Phone: (_____) _______‐ ____________  Cell Phone: (_____) _______‐ _____________ 

Work Phone: (_____) _______‐ ____________Employment Status:    

 Employed       Self‐Employed  

 Homemaker   Unemployed    

 Retired            Disabled    

 Full‐Time Student 

Occupation:  Employer: 

If self‐employed, type of business:    Name of Business:   

CEF STAFF  OFFICE USE ONLY 

 

 

 Application Reviewed  Data Entered  Scanned 

CEF SCHOOL OFFICE USE ONLYSchool Code:   

School Name:   

New Applicant (   ) Transfer Applicant (   ) Student ID #: 

Cycle 2Application for  

Tuition Assistance 2016/2017 

Page 1 of 3

LIST OF INCOME SOURCES 

PARENT/GUARDIAN INFORMATION 

PARENT/GUARDIAN A  

FIRST NAME:________________________ 

LAST NAME:________________________

PARENT/GUARDIAN B  

FIRST NAME:________________________  

LAST NAME:________________________ 

PRINCIPAL DOCUMENT CHECKLIST 

CEF OFFICE 

USE ONLY

LIST OF ANNUAL SOURCES OF INCOME FOR TAX YEAR 2014 

 Single    Married Filing Joint  

 Married Filed Separately    

 Head of Household   

 Do Not File 

 Single    Married Filing Joint  

 Married Filed Separately    

 Head of Household   

 Do Not File 

 

 

Taxable Income  Please provide the corresponding Supporting Documents 

Employment Income (Form 1040, Line 7)   $  $     

Business/Self Employment Income  (Schedule C: Form 1040, Line 12) 

$  $     

Capital Gains (Schedule D: Form 1040, Line 13)  $  $     

Rental, Partnership, S Corp, Trust Income  (Schedule E: Form 1040, Line 17)  $  $     

Farm Income (Schedule F: Form 1040, Line 18)  $  $     

Pension  (Form 1040, Line 16 or Annual Pension Statement)  $  $     

Unemployment (Form 1040, Line 19)  $  $     

SSI (Social Security)  (Form 1040, Line 20 or SSI Statement)  $  $     

Cash Income (Notarized Statement of Income)  $  $     

Annual distribution from Investments (Trust funds, CDs, Stocks, IRAs, 401Ks, etc.)  $  $     

Non Taxable Income  Please provide the corresponding Supporting Documents 

Public Housing Assistance/Section 8 (Section 8 Allotment Statement)  $  $     

CalWORKs: Welfare/TANF (CalWORKS Benefit Amount Statement) 

$  $     

CalFresh: Food Stamps (CalFresh Benefit Amount Statement)  $  $     

Child Support  (Letter w/ Amount of Support)  $  $     

Disability (Annual Disability Statement or Supplemental SSI)  $  $     

Alimony (Letter w/ Amount of Support)  $  $     

Other Income (Explain)  $  $     

TOTALS          

FAMILY EXPENSES 

Where does this family live? 

 Monthly Mortgage or Rent: $_____________ 

 Own/Mortgage Home     Rent Home/Apartment     Live in the home of Relative/Friend    Section 8 Housing 

 Federal Housing     Shelter/Temporary Housing     We are Homeless (Streets/Car)      Other  ____________ 

If you are living with friends/family, how much do you contribute monthly?  $____________     

Is your home currently in foreclosure or short sale?   Yes     No 

FAMILY VEHICLES  Vehicle A: Car Make: _______________    Model: _______________ Year: ________    Monthly Car Payment $____________ # of Months left on car loan: __________ 

Vehicle B: Car Make: _______________    Model: _______________ Year: ________    Monthly Car Payment $____________ # of Months left on car loan: __________ 

Do you use either vehicle for Business?    Vehicle A      Vehicle B 

Page 2 of 3Information on this application will remain confidential.

BUDGET REPORT (completed only if applicant is applying for the Principal’s Grant)

MONTHLY PAYMENT MONTHLY PAYMENT HOUSING TRANSPORTATION Mortgage/Rent $ Car Payment(s) $ Repairs/Maintenance Fees $ Gas $ UTILITIES Car Insurance $ Electricity $ PERSONAL Gas $ Health Insurance $ Water $ Life Insurance $ Phone/Cable/Internet $ Disability Insurance $ Trash $ Long-Term Care Insurance $ Food $ Child Care $ OTHER (fill in below) Child’s Tuition $

TOTAL MONTHLY EXPENSES $

List all property owned including houses, businesses and other income properties.

Assets (as of the date of this application): Cash, savings and checking accounts, stocks, bonds, retirement accounts: $ Home equity (renters enter $0): $

FAMILY EXPENSES

Where does the family currently live? (circle one) Own home Rented Home/Apartment Live in the home of parent/relative/friend Federal housing Section 8 housing Temporary housing Other

Total Monthly Mortgage/Rent for housing:

How much does the family contribute towards mortgage/rent?

Is your home currently in foreclosure or short sale?

How many cars does your family currently own/lease?

Car Information: Make Model Monthly Payment

1. 2. Please use the space below to write a brief comment to help us understand your financial need/or special circumstances. ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

POLICY FOR PROOF OF INCOME

Proof of Income x Copies of 2015 Tax Returns or 2014 Tax Returns with 2015 W-2’s x Page 1 and 2 of Tax Returns (1040, 1040A, 1040EZ) x Copies of all supporting tax schedules if you have income from any of following sources:

o Business (Form 1040, line 12 – Submit Schedule C or C-EZ: Page 1, 2 & other expenses) o Rental Property, Partnership, Trust (form 1040, line 17 – submit schedule E: Page 1 & page 2) o S Corporation (Form 1040, line 17 – submit schedule E: page 2, form 11205)

x If laid off or unemployed please supply employer’s letter/notification of layoff and a copy of unemployment benefits x Cash Income – Statement of income from employer x Non-Taxable Income - Copies of all supporting documentation (Social Security Income, CALWORKS: Welfare/TANF,

Child Support, Calfresh: Food Stamps, Worker Compensation, Disability, Alimony, Section 8: Public Housing)

In order to receive Financial Aid from St. Genevieve High School, parent/guardian must agree to participate in school wide fundraisers:

All recipients must sell fiesta raffle tickets totaling $300. Note: the cost of these tickets will be added to your FACTS tuition account. If granted more than $2,000 you will be asked to participate in additional fundraising activities, including:

x Parent casino night (must purchase two tickets for each event) x Each family must sell a total amount of SCRIP that equals the amount of the financial aid received

SERVICE HOURS: Parents agree to complete required service hours or pay $15 for each hour not served.

Spirit Grant =30 Hours Principal’s Grant = Total hours will be determined according to the amount granted

Terms and Conditions: Please review the application instructions and requested documents one final time. x This application and the amount granted by St Genevieve High School to your family should not be discussed with

anyone. If confidentiality is breached, we reserve the right to rescind your tuition assistance. x If using bus service, $1,000 will be added to your FACTS account as Transportation. x Registration fee must be paid. x Your FACTS account must be set up to insure the finalization of your application. x Any student cleared from CEF waitlist who has received $2,000 or more from SGHS financial aid program will not

receive additional funding once CEF waitlist is cleared. x You will be contacted by the tuition office for an appointment for all Principal’s grants. x Once your application is processed and finalized you will receive an email or mail from FACTS Management company

indicating the adjustment(s) made to your account. Students must attend all school wide major events: Night schools, Special events, Open House, Masses. Students must comply with the terms of their application. We ask all parents to attend Night Schools.

ST. GENEVIEVE HIGH SCHOOL FINANCIAL AID TERMS AND CONDITIONS

St. Genevieve High School Financial Aid Program is designed to assist students with tuition for enrollment. All information submitted in this application is confidential and provided for the purposes of determining eligibility for aid from Saint Genevieve High School. By signing this application, you verify that you understand and agree that all information provided on this form is

true, accurate and complete to the best of your knowledge. You agree that you have provided all requested forms for proof of income. St. Genevieve High School is under no obligation to review or accept any application that is incomplete, ineligible, unsigned, has not provided adequate proof of income, or has discrepancies or lack of information that makes it impossible to render a funding decision. You further agree that your application was submitted before the program deadline of January 29, 2016 for new students and March 15, 2016 for all returning students. Failure to submit your application by the deadline is

grounds for refusal.

Saint Genevieve High School has limited budget for financial aid. We reserve the right to deny your request due to budget constraints. Your signature below indicates that you have read and understand the terms of this program. The information provided on this application is true, accurate and complete, and legal proof of income has been provided. We thank you for

giving us the opportunity to serve you family. Signature of Parent/Guardian A: ________________________________________________________ Date: ______________ Signature of Parent/Guardian B: ________________________________________________________ Date: ______________

Parent Service Hour Intent Form

Dear Parents/Guardians, I would like to give you an idea how the system works here at St. Genevieve High School for parent service hours. We have been fortunate to have parents who have taken the initiative of heading two main activities.

1. The “Bake Sale” witch happens the last Sunday of each month at the Parish 2. The “Snack Bar at Sport Events” at most of our home games

We also have an opportunity for people who cannot come and work. They could donate goods, money towards their hours. Below is a possible list of duties you could choose from. Please, mark your intentions and submit this form with the packet.

I would like to participate in “Bake Sale” (limited positions available) Saturday & Sunday event I would like to participate in Sports Event (limited positions available) Evening events I would like to participate in cooking at home for service I would like to donate “Funds” (for every $ 8.00 donated you will earn 1 hour of service) I would like to donate “Goods” (for every $8.00 spent will earn you 1 hour of service) I would like to raise money toward the service hours I am available during the day for office help

We would like to hear from parents who have any special ideas or contacts. Student’s Name: ___________________________________Grade_______________ Parent/Guardian Name: _________________________________________________ Day Time Phone number: __________________________Cell:__________________