Application For Financial Aid - Mechina

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Application for Financial Assistance 2024-2025/5784-5785

Center for the Advancement of Jewish Education

Family Information

Father's Name*

First Name

Last Name

Mother's Name*

First Name

Last Name

Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Home Phone

Father's Cell Phone*

Mother's Cell Phone*

Social Security # (Father)

Social Security # (Mother)

Occupation(s) Father*

Occupation(s) Mother*

Name of Employers (Father)*

Name of Employers (Mother)*

Do you have a financial interest in the company? (Father)*

Yes No

Do you have a financial interest in the company? (Mother)*

Yes No

I (we) certify that all of the financial information submitted on this application form is accurate and that I (we) will inform the school of any changes in status which may occur during the school year.

I(we) hereby authorize Mechina High School to make such credit inquiries as it deems necessary. I (we) hereby direct any and all employers, banks, credit card companies, and credit reporting agencies to release and and all financial information, records, reports and documentation to Mechina High School without limitation, until this authorization is revoked in writing by the undersigned.

Father Signature*

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Use your mouse or finger to draw your signature above

Date*

Mother Signature*

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Date*

Current Tuition Information

Students Enrolled in our School*

Grade Level, Tuition and Fees

Total Amout of Full Tuition*

TOTAL AMOUNT THAT YOU ARE ABLE TO PAY*

Other Children, not attending our school*

Age, Name of School, Tuition + Fees Total Amount

Assets

Cash on Hand

Cash in Banks & Brokerage Accounts

Provide bank name and account #

Stock/Bonds/Mutual Funds/Notes

(Provide name and account #)

Real Estate

Personal Residence, Vacation Residence and Other Properties

Automobile #1

Make, Model, Year and $

Automobile #2

Make, Model, Year and $

Automobile #3

Make, Model, Year and $

Personal Property

Home Contents & Jewelry

Cash value of life insurance policies

Other Assets

TOTAL ASSETS

Liabilities

In addition to total liability, please provide: Name of Lender, Account #, Balance & Minimum Payment

Mortgage Loans

Home Equity Loans

Auto Loans

Installment Loans

Credit Card Balances

Unpaid Judgements or Liens (provide information)

TOTAL LIABILTIES

NET WORTH (Assets Less Liabilites)

Annual Family Income

Wages/Salary-Father

Wages/Salary-Mother

Short Answer

Self Employment Income

Interest and Dividend Income

Disability Benefits

Pension Benefits

Net Rental Income

Alimony Received

Child Support Received

Income from Insurance Benefits

Other Misc. Income

TOTAL INCOME

Monthly Family Expenses

Rent Payment

Mortgage Payments

Principal, Interest, Taxes and Insurance)

Real Estate Taxes

If paid seperately, and not included in mortgage payments)

Alimony Paid Out

Child Support Paid Out

Auto Payment- Loan or Lease Payment

Credit Card or Installment Loan Payments

Auto Expenses

(Gas, Insurance & Repairs)

Utilities

Telephone

Home Repairs & Maintenance

Food & Supplies

Insurance-Health

Insurance-Auto

Insurance- Life & Disability

Clothing

Maid, Housekeeper or Nanny

Medical and Dental

Synagogue Dues

J.C.C/Health Club Memberships

Donations

Pool Care

MONTHLY EXPENSES (SUB-TOTAL)

Monthly Family Expenses (continued)

Entertainment & Vacations

Grooming, Manicure & Cosmetics

Cable Television

Pet Expenses

Other (detail)

TOTAL MONTHLY EXPENSES

IRS Form

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Bank Form

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Family Information

Current Tuition Information

Ancillary Income and Expenses

Assets

Liabilities

Annual Family Income

Monthly Family Expenses

Monthly Family Expenses (continued)