Family Tuition Plan Application Family Tuition Plan Application If you are human, leave this field blank. School Year Select a School Year * 2019-2020 Applicant Information First name * Last Name * Address * City * Zip * Contact Phone * Email Address * Marital Status * Divorced Married Remarried Separated Widowed Single Never Married Residing With Significant Other Other Other Marital Status * Which local parish do you support? * Holy Family Our Lady of Lourdes Our Lady of the River Our Lady of Victory Sacred Heart St. Alphonsus St. Andrew’s St. Ann St. Anthony's St. John Vianney St. Paul the Apostle St. Peter's St. Mary Davenport St. Mary Moline None Other Other Local Parish * Spouse/Significant Other Spouse/Significant Other First Name Spouse/Significant Other Last Name * Contact Phone * Email * Catholic School Employment Are you or your spouse/significant other employed by a Scott County Catholic School? * Yes No What is your position? * Catholic School Employer * All Saints Assumption High School John F. Kennedy Lourdes St. Paul's Please list all students for whom you are seeking assistance. First Name * Last Name * Relationship * Son Daughter Niece Nephew Grandson Granddaughter Other School Name * All Saints Assumption High School John F. Kennedy Lourdes St. Paul's Grade * K 1 2 3 4 5 6 7 8 9 10 11 12 Add Another Student Remove Household Information I am responsible for x% of tuition * Are there any other persons living in your home? * Yes No Please list any other persons living in your home. First Name * Last Name * Relationship to Applicant * Add Remove Housing Information Do you rent or own your house? * Rent Own What is your monthly rent/mortgage payment? * What percentage of housing costs are paid by applicant? * Additional Income (Please list monthly amount received) Child Support * Food Assistance * Social Security Income * Dependent Social Security Income * Unemployment * FIP (Family Investment Program) * Retirement Income * Loans/Gifts from Family and/or Friends * Do you receive income from another source not listed above or reflected on your tax return? Yes No Other Income Type * Other Income Amount * Other Expenses (Please list monthly amount paid) Alimony * Child Support * Extenuating Circumstances Extenuating Circumstances An income earning member of my house changed jobs in the last 12 months An income earning member is currently unemployed Extreme medical expenses Other Please supply additional and specific information regarding extenuating circumstances below (ex: name of unemployed, name of person who changed jobs, etc) * Paystub Information Please upload the three most recent paystubs (pdf or jpg files accepted) OR check the box indicating the three most recent paystubs will be sent by mail. APPLICATIONS CANNOT BE PROCESSED UNTIL ALL DOCUMENTATION HAS BEEN RECEIVED. Send Paystub I will mail the three most recent paystubs instead of uploading them Paystub 1 * Uploading Files. Please Wait. Drop a file here or click to upload Choose File Maximum upload size: 104.86MB Paystub 2 * Drop a file here or click to upload Choose File Maximum upload size: 104.86MB Paystub 3 * Drop a file here or click to upload Choose File Maximum upload size: 104.86MB Medical Bill Information Please upload any relevant medical bills/statements OR check the box indicating any relevant medical bills/statements will be sent by mail. Send Medical Bills/Statements I will mail any relevant medical bills/statements instead of uploading them Medical Bills/Statements * Drop a file here or click to upload Choose File Maximum upload size: 104.86MB Tax Information Please upload your IOWA 1040 Tax Return (not Federal), and Schedule C, D, and/or F if they are part of your tax return (pdf or jpg files accepted). If you did not file taxes in Iowa, please upload your Federal 1040 Tax Return. Tax Documents * I will upload my tax documents below I was not required to file taxes I do not have a digital copy of my tax forms, but will mail a hard copy to PO Box 1597, Davenport, IA 52809. APPLICATIONS CANNOT BE PROCESSED UNTIL ALL TAX DOCUMENTATION HAS BEEN RECEIVED. I have filed for an extension, and have uploaded a copy of my Extension for Filing Request and W2 forms for all income earning members of my household Tax Document Upload * Drop a file here or click to upload Choose File Maximum upload size: 104.86MB Tax Document Upload 2 Drop a file here or click to upload Choose File Maximum upload size: 104.86MB Extension for Filing Request and W2 Form Upload * Drop a file here or click to upload Choose File Maximum upload size: 104.86MB Terms & Conditions Terms & Conditions Agreement * I verify that all information above, including the uploaded tax return, is true and accurate. I understand my application CANNOT BE PROCESSED until all documentation I may be mailing instead of uploading to this application (tax return, paystubs, medical bills, etc.) has been received. I understand that grants received outside the Family Tuition Plan may affect FTP grant amounts, and applications made after June 30 will not receive maximum funding. I understand applications may take up to 6 weeks to be processed. Signature * Submit
