Brighter Horizon School of Baton Rouge
*** A Full Time Islamic School ***
1896 Wooddale Blvd. Baton Rouge, LA 70806
(225) 927-2521
Application Form for Tuition Reduction and/or Fee Payment Assistance
Please Print
Financial assistance is based on family income, family size, number of children enrolled in Brighter Horizon School and availability of funds.
Parent Data:
Father’s Name: ______
Last First Middle
Mother’s Name: ______
Last First Middle
Residential Address: ______
Street Apt. #
______
City State Zip
Home Phone: ______Cell Phone: ______
Number of People Residing in Home: ______(Family Size)
Number of Students Enrolled in Brighter Horizon School of Baton Rouge: ______
Total Family Income: $______, per ____Week _____Month _____Annual
Please provide last three paycheck stubs, or other legal proof of income.
Father’s work phone:______Mother’s work phone: ______
Brief summary of why I am requesting assistance to pay my child’s tuition:
(if more room is needed, please continue on back of page)
______
______
______
My family can afford to pay a maximum of $______per month including all children enrolled.
Student(s) Data:
Student Full Name: ______Grade: _____
Student Full Name: ______Grade: _____
Student Full Name: ______Grade: _____
Student Full Name: ______Grade: _____
Student Full Name: ______Grade: _____
Student Full Name: ______Grade: _____
Student Full Name: ______Grade: _____
I am requesting financial assistance:
q To help pay tuition for the entire academic year
q To help pay tuition temporarily, for the month(s) of ______
q To establish a payment plan for the payment of Registration Fees and Textbook Fees
Financial assistance may be awarded temporarily or for the entire academic year.
Please initial the following:
¾ Proof of family income must accompany this Tuition Assistance Application.
¾ Proof of family income should be reported during the first week of December.
¾ Proof of family income should be reported during the first week of March.
¾ Changes in income should be reported within ten working days of the change.
¾ Changes may affect monthly tuition amount.
Agreement:
I understand that I must report any changes that would affect my child’s eligibility criteria within ten working days of the change. I understand that providing false information is subject to penalty and certify that all information given is true and correct to the best of my knowledge.
______
Signature of head of household
This application will not be considered unless it is completed in full and proof of income is provided. This form should be submitted to the school’s office.
Brighter Horizon School of Baton Rouge does not discriminate in enrollment or hiring practices.