St. Mary School Luxemburg - Tuition Assistance Form
Name of person completing application form *
Your answer
Child #1 - Name of oldest child in your household under the age of 18 *
Your answer
Child #1 - Age and/or grade of child as of September 1, 2019 *
Your answer
Child #1 - Has your child attended St. Mary School in Luxemburg previously? *
Your answer
Child #2 - Name of your second oldest child in your household under the age of 18
Your answer
Child #2 - Age and/or grade of child as of September 1, 2019
Your answer
Child #2 - Has your child attended St. Mary School in Luxemburg previously?
Your answer
Child #3 - Name of your third oldest child in your household under the age of 18
Your answer
Child #3 - Age and/or grade of child as of September 1, 2019
Your answer
Child #3 - Has your child attended St. Mary School in Luxemburg previously?
Your answer
Child #4+ - Name of any other children under the age of 18 in your house hold
Your answer
Child #4+ Age and/or grade of any other children as of September 1, 2019
Your answer
Child #4+ - Has your child(ren) attended St. Mary School in Luxemburg previously?
Your answer
Total number of members in your household under 18 (Parents + children) *
Your answer
Mother's Name *
Your answer
Mother's Address (house, city, state, zip)
Your answer
Mother's phone number *
Your answer
Mother's email address *
Your answer
If the mother is a registered member of a parish, what parish? *
Your answer
Mother's Gross Income as reported on her 2018 taxes *
Your answer
Father's Name *
Your answer
Father's Address (house, city, state, zip) *
Your answer
Father's phone number *
Your answer
Father's email address *
Your answer
If the father is a registered member of a parish, what parish? *
Your answer
Father's Gross Income as reported on his 2018 taxes *
Your answer
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