FINANCIAL ASSISTANCE FORM

Welcome! We are committed to developing future entrepreneurs, critical thinkers and innovators that are ready for a life-long journey of exponential growth, and, if you have made it this far, it is because you believe in that commitment too. We understand that not all families that would like to send their child to a school like Quadrat have the means to do so, so we are offering need-based financial assistance for families.

Please complete this form for each student you would like to request financial assistance for. Should you have any questions about filling out this form, please contact svetlana@quadratacademy.com.

You will require the following documents in this application:

· 1040, 1099 or similar tax form from the previous year for parent(s)

· Current bank statement(s)

· Most recent paycheck(s)

All information reported on this form will be kept private.

PARENT/GUARDIAN INFORMATION

First Name (Parent/Guardian 1) *

Last Name *

Email Address *

First Name (Parent/Guardian 2)

Last Name

Email Address

STUDENT INFORMATION

Student's First Name *

Student's Last Name *

D.O.B. * +

INCOME for ALL PARENT(S)/GUARDIAN(S)

Annual wages, tips and other compensation *

Annual income from a business, farm, trust, corporation or partnership *

MONTHLY income from welfare, including food stamps or unemployment *

MONTHLY average amount received for child support or alimony *

ANNUAL interest or dividends *

Miscellaneous ANNUAL income (taxable) *

Please upload a copy of your most recent paycheck(s). You may upload more than one file. *

INCOME TAX FORMS

Please upload a copy of your 1040, 1099 or similar tax form(s) from previous year. *

ASSETS for ALL PARENT(S)/GUARDIAN(S)

Do you pay rent? *

Yes

If yes, what is your monthly rent payment?

If you are a homeowner, what is the current market value of your home?

If you are a homeowner, what is your monthly mortgage payment?

Please complete the following section if you own any other properties in addition to your home, such as rental properties, land, etc.

Current market value of your properties

Amount owed on loan(s)/mortgage payment(s)

Annual gross property income

Annual gross property expenses

Please complete the following section if you own or lease any automobiles.

Number of vehicles owned by household

Current market value of owned automobiles

Total debt

Number of vehicles leased by household

Monthly lease payment(s)

Please complete the following section if you have a savings account, stocks, etc.

Current value of the following accounts: stocks, securities, bonds, mutual funds

Current value of the following accounts: checking, savings, cash, CD's

Please upload a copy of your current CHECKING bank statement(s). You may upload more than one file. *

Please upload a copy of your current SAVINGS bank statement(s). You may upload more than one file.

EXPENSES and DEBT

MEDICAL INSURANCE

Annual insurance premium(s) for Medical/Dental *

Annual insurance premium(s) for Prescription Drugs *

Other annual insurance premium(s), i.e. prescription eyewear

Alimony and Child Support Payments

Annual child support paid to others *

Annual alimony paid to others *

Miscellaneous Debt

Outstanding dollar amount on credit card(s)

Outstanding dollar amount on student loan(s)

Outstanding dollar amount on bank loan(s) (Please do not include home/automobile loans as they are noted in previous sections)

Miscellaneous debt/loan(s)

CONTRIBUTION TO EDUCATION

How much can Parent(s)/Guardian(s) contribute toward tuition on a monthly basis? *

How much can other sources or individuals contribute toward tuition?

CONFIRMATION AND SUBMISSION

Is there anything else we should know at this time?

Please sign below to verify that all information provided in this document is true. *

clear

Date of Signature * +

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