Village Home Financial Aid Application 2017/2018

Financial Aid is awarded for the entire academic year in per term amounts. Aid is per student, and is not transferable between students and/or terms. Choices and Day Program tuition are not eligible for financial aid.

Deadline for first consideration was July 24, 2017. Applications completed now will be placed into a separate pool for later consideration on a funds available basis later in the term or year. Acceptance of this form by Village Home does not in any way constitute or confirm an award of financial aid. Aid amounts are determined by 1) income based eligibility, 2) the total amount of aid available and 3) the number of students receiving aid. Incomplete forms will not be processed. Families who have applied for Financial Aid by the July 24, 2017 deadline will receive notification no later than July 31, 2017. All information regarding Financial Aid will be treated in the strictest of confidence by Village Home.

Email address *
Student Last Name *
Your answer
Student First Name *
One student per form, please
Your answer
Primary Campus for 2017/2018 *
Which campus will this student attended primarily?
Contact Parent First Name *
Person to contact regarding the information on this form and any award granted.
Your answer
Contact Parent Last Name *
Your answer
Contact Parent Phone *
Your answer
Contact Parent Email *
Your answer
Financial Eligibility Questions
Please submit a copy of your 2016 federal income tax filing showing the front info page and the AGI line page (you may black out SSNs if desired). Your application is not complete until this is received in our office. You may email ( by 7/24/17 or mail postmarked by 7/20/17 (PO Box 2093 Beaverton OR 97075) .
How many people are in your household? *
Include yourself, your spouse, and other people if they now live with you and you provide more than half their support from July 1 through June 30, including your children.
What was your household’s adjusted gross income for 2016? *
Form 1040 line 37; 1040A line 21; 1040EZ line 4
Your answer
Changes in family financial circumstances and appeals
Village Home recognizes that occasionally a family may experience a sudden and precipitous change in financial circumstances after filing taxes, or may be experiencing circumstances not adequately represented on taxes. You may use this space to provide an explanation, including an estimate of its financial impact on your household income.
Your answer
I have reviewed the information provided in this financial aid form and agree that it is correct. *
Full Name of person certifying the accuracy of this form *
Your answer
A copy of your responses will be emailed to the address you provided.
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