Applying for Sto Funds for 2011-2012

Christian School

TUITION ASSISTANCE SERVICE

APPLYING FOR STO FUNDS FOR 2011-2012

The Christian schools in Central Iowa, Newton, Oskaloosa, Pella, Peoria, and Sully are part of the Legacy of Grace School Tuition Organization (STO). All will be using our services to apply for STO funds and school funds, ifapplicable. One application covers all schools. You are eligible for STO funds if your income, as found on Line 22 of your IRS 1040 (Line 15 of 1040A) is not more than three times the poverty rate, which is as follows:

Family SizeIncome LevelEligibility Level

2 $14,710 $44,130

3 18,530 55,590

4 22,350 67,050

5 26,170 78,510

6 29,990 89,970

7 33,810 101,430

8 37,630 112,890

9 41,450 124,350

10 45,270 135,810

11 49,090 147,270

12 52,910 158,730

If you are eligible and wish to be considered for STO (and any applicable school) funds, complete the information below:

Parent Name______

Address______

Street/PO BoxCityState Zip

Names of Children 2011-12 GradeSchool to attend in 2011-12

1.______

2.______

3.______

4.______

5.______

6.______

Total number of persons in household_____

Income as shown on Line 22 of your IRS 1040 (Line 15 of 1040A) $______Any special circumstances you wish to be considered should be reported on the reverse side of this form.

You may transmit this application in one of three ways by the April 30 deadline:

1. Mail this form and the first page only (not electronic filing statement) showing Line 22 income (Line 15 of 1040 A) of your 2010 Federal Income Tax Return to: Christian School Tuition Assistance Service, P.O. Box 111, Fulton, IL 61252. For your convenience a self-addressed envelope is enclosed.

1. Fax this form and the first page only (not electronic filing statement) showing Line 22 income of your 2010 Federal Income Tax Return to our fax 815-589-2439.

1. Scan this form and the first page only (not electronic filing statement) showing Line 22 income of your 2010 Federal Income Tax Return email to: .

SPECIAL CIRCUMSTANCES

Parent Name______

Address______

______

CityStateZip

Phone______

Please consider the following circumstances when reviewing our application:

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