Student Name *

First Name

Last Name

Student Birth Date *

MM

DD

YYYY

Parent or Guardian name: *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Primary Phone *

(###)

###

####

Another Phone

(###)

###

####

Do parents reside in the same household? *

Yes

No

Marital status *

Married

Divorced

Separated

Single

Does your family qualify for the Federal Free School Lunch Program? *

Yes

No

What percentage of tuition reduction are you requesting? *

100%

75%

50%

25%

Could you contribute to your child's or teen's tuition in other ways? *

Volunteer

Supplies

Other (describe below)

Proof of income is required - I have emailed a copy to Victoria@baddogarts.org *

Most Current Tax Return

Current W2

DWS Financial Benefit Statement

Employer Verification Statement

House Authority Annual Income Form

Other (please specify below)

Date *

MM

DD

YYYY