Tuition Grant Program
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1
2New York State Council
Knights of Columbus
1. Other Financial Assistance:
High School
Will student be receiving any other financial assistance or scholarships?
YES
NO
If YES , ANNUAL amount: $ _____________________________
Tuition Grant Program
IF YES, list organization(s):_______________________________________________
2. Father's Employer: _________________________________________________
Address:_______________________________________________________________
Annual Gross Salary: $_________________ Years of Service :_______________
Occupation/Position:_________________________________
Age:__________
If not employed is Father disabled? _______ Term of Disability:__________________
3. Mother's Employer: _______________________________________________
Address:_______________________________________________________________
Annual Gross Salary: $_________________ Years of Service:__________
Occupation/Position:___________________________________ Age: _________
If not employed is Mother disabled? _______ Term of Disability:__________________
4. Other Sources of Income:
Working Children: $___________
Union: $_____________ Social Security: $___________ Insurance:$____________
Savings Accounts: $_____________ Welfare:$___________ Pensions: $____________
5. Family Information
Number of Dependent Children:________
Living Home:__________ In School:__________ Working :________
TUITION GRANT
List Child(ren)'s Name, Age, School Attending, Grade:
____________________________________________________________________
____________________________________________________________________
APPLICATION
____________________________________________________________________
6. Indebtedness Information: Home:
Own:___ Rent:____
Monthly Rent: $___________ Mortgage Payment (w/o Taxes):$_________________
** Important ** Filing Deadline:
Yearly:$_________________
Annual Real Estate Taxes:$______________
Applications for applicants entering the 9th Grade must
be submitted in time to arrive at the N.Y. State
7. Other Financial Obligations:
Council's Executive Office NO LATER THAN April 15th
Type
Bank/Finance Company
Unpaid Balance
Monthly Payment
preceding the September school start-up date the
___________________________________________________________________
applicant plans to enter high school.
___________________________________________________________________
Completed Tuition Grant applications should be
___________________________________________________________________
mailed/submitted to:
8. Attach copies of all Federal Income Tax Forms for previous year which just ended.
Salvatore A. Restivo, PSD
For Further Information please contact:
NY State Council Knights of Columbus
631-366-3787
201 Portion Road, Suite A
Lake Ronkonkoma, N Y 11779
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