Scott County Catholic Schools

School Year

Select a School Year *

Applicant Information

First name *

Last Name *

Address *

City *

Zip *

Contact Phone *

Email Address *

Marital Status *

Other Marital Status *

Which local parish do you support? *

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 *

Please list all students for whom you are seeking assistance.

First Name *

Last Name *

Relationship *

School Name *

Grade *

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

An income earning member in my household 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.

Paystub 1 *

Maximum upload size: 157.29MB

Paystub 2 *

Maximum upload size: 157.29MB

Paystub 3 *

Maximum upload size: 157.29MB

Medical Bill Information

Please upload any relevant medical bills/statements.

Medical Bills/Statements *

Maximum upload size: 157.29MB

Tax Information

Tax Documents *

I will upload my Iowa 1040 and Schedule C, E, and/or F if they are part of my return below - pdf or image/photo files accepted.

I did not file taxes in Iowa. I will upload my Federal 1040 and Schedule C, E, and/or F if they are part of my return below - pdf or image/photo files are accepted.

I was not required to file taxes

Tax Document Upload *

Maximum upload size: 157.29MB

Extension for Filing Request and W2 Form Upload *

Maximum upload size: 157.29MB

Terms & Conditions

Terms & Conditions Agreement *

I verify that all information above, including the uploaded tax return, is true and accurate.

I understand applications may take up to 6 weeks to be processed.

I understand that applications made after June 30 will not receive maximum funding.

I understand my application CANNOT BE PROCESSED until all necessary documents (tax return, paystubs, medical bills, etc.) have been received, and applications that remain incomplete at June 30 will not receive maximum funding.

I understand that grants received outside the Family Tuition Plan may affect FTP grant amounts.

Signature *