APPLICATION FOR CONCESSIONAL FEES

Transcription

1 APPLICATION FOR CONCESSIONAL FEES Family Name: Family Number: Students Enrlled at Sacred Heart Cllege: Name Year Level Checklist I/We have fr all carers: Cmpleted and Signed this Applicatin Attached the mst recent Ntice f Assessment Attached Payslips fr the last 2 pay perids Attached 2 mst recent Centrelink payment advice slips r statements Attached Evidence f mrtgage repayment r rental agreement shwing cst Attached Cpy f Health Care Card Attached any ther infrmatin in supprt f this Applicatin I/We acknwledge that the infrmatin I/we have prvided n the fllwing pages is prvided t enable the Cllege t fully cnsider my/ur applicatin fr a variatin t the nrmal fee cnditins. I/we certify that the infrmatin prvided by me/us is true and crrect and nthing has been mitted which wuld lead the Cllege t make an incrrect assessment. We als agree t a meeting with the Business Manager as required. Signature f Parent/Carer 1 Date Signature f Parent/Carer 2 Date

2 SECTION 1 Parent/Carer 1 Details (place a tick in the relevant bx) FULL NAME OF PARENT/CARER 1: MARITAL STATUS: single married/de fact separated divrced widwed ADDRESS: PHONE NUMBERS: mbile: hme: wrk: RESIDENTIAL STATUS: renting paying ff hme (mrtgage) wn hme Where applicable, insert weekly mrtgage r rent payments in item 11 n page 6. EMPLOYMENT STATUS: emplyed self-emplyed hme duties unemplyed (gvernment supprt) ther (please describe) IF EMPLOYED: Occupatin: Emplyer: Date Started: Status: full time part time casual cntract fr a term (terminatin date) If yu have mre than ne emplyer, please include full details f each Please write yur average weekly grss incme in item 1 n page 6 and attach cpies f 2 recent payslips & mst recent Ntice f Assessment IF SELF EMPLOYED: What is yur ccupatin? Please write yur average weekly grss incme in item 1 n page 6 & attach cpy f mst recent Ntice f Assessment IF RECEIVING GOVERNMENT SUPPORT (CENTRELINK PAYMENTS): Hw lng have yu been receiving Gvernment Supprt? What type/s f benefit d yu receive? Attach cpies f 2 mst recent Centrelink payment advice slips D yu have a current Health Care Card? Yes N (If yes please prvide a cpy and prceed t Parent/Carer 2 Details. If Parent/Carer 2 is nt applicable, prceed t Sectin 4 n page 8. Health Care Card Hlders are nt required t cmplete Sectins 2 & 3 hwever if yu require a budget template then yu are encuraged t utilise these sectins) DO YOU RECEIVE ANY OF THE FOLLOWING: Child maintenance/supprt Interest r dividends frm investments Rental receipts frm any prperty Other incme (please describe) Include the weekly equivalent f the incme abve in items 3 & 4 n Page 6 2

3 HAVE YOU RECEIVED ANY LUMP SUM PAYMENTS IN THE LAST 2 YEARS? This can be as a result f terminatin f emplyment, redundancy, cmpensatin, legal actin, inheritance r superannuatin Yes N If yes please state the nature f the payment, the amunt, and the date received: DO YOU HAVE ANY SALARY SACRIFICE OR FRINGE BENEFIT ARRANGEMENTS WITH YOUR EMPLOYER? This includes any mtr vehicle r equipment prvisins, payment f expenses r additinal superannuatin cntributins Yes N If yes please prvide details: Include the weekly equivalent f the net amunt in item 5 n page 6 FULL NAME OF PARENT/CARER 2: Parent/Carer 2 Details (place a tick in the relevant bx) MARITAL STATUS: single married/de fact separated divrced widwed ADDRESS: PHONE NUMBERS: mbile: hme: wrk: RESIDENTIAL STATUS: renting paying ff hme (mrtgage) wn hme Where applicable, insert weekly mrtgage r rent payments in item 11 n page 6. EMPLOYMENT STATUS: emplyed self-emplyed hme duties unemplyed (gvernment supprt) ther (please describe) IF EMPLOYED: Occupatin: Emplyer: Date Started: Status: full time part time casual cntract fr a term (terminatin date) If yu have mre than ne emplyer, please include full details f each Please write yur average weekly grss incme in item 1 n page 6 and attach cpies f 2 recent payslips & mst recent Ntice f Assessment IF SELF EMPLOYED: What is yur ccupatin? Please write yur average weekly grss incme in item 1 n page 6 & attach cpy f mst recent Ntice f Assessment 3

4 IF RECEIVING GOVERNMENT SUPPORT (CENTRELINK PAYMENTS): Hw lng have yu been receiving Gvernment Supprt? What type/s f benefit d yu receive? Attach cpies f 2 mst recent Centrelink payment advice slips D yu have a current Health Care Card? Yes N (If yes please prvide a cpy and prceed t Sectin 4 n page 8. Health Care Card Hlders are nt required t cmplete Sectins 2 & 3 hwever if yu require a budget template then yu are encuraged t utilise these wrksheets) DO YOU RECEIVE ANY OF THE FOLLOWING: Child maintenance/supprt Interest r dividends frm investments Rental receipts frm any prperty Other incme (please describe) Include the weekly equivalent f the incme abve in items 3 & 4 n Page 6 HAVE YOU RECEIVED ANY LUMP SUM PAYMENTS IN THE LAST 2 YEARS? This can be as a result f terminatin f emplyment, redundancy, cmpensatin, legal actin, inheritance r superannuatin Yes N If yes please state the nature f the payment, the amunt, and the date received: DO YOU HAVE ANY SALARY SACRIFICE OR FRINGE BENEFIT ARRANGEMENTS WITH YOUR EMPLOYER? This includes any mtr vehicle r equipment prvisins, payment f expenses r additinal superannuatin cntributins Yes N If yes please prvide details: Include the weekly equivalent f the net amunt in item 5 n page 6 4

5 SECTION 2 Other Infrmatin Number f Persns Living in the family hme f the student Number Parents/Adult carers (wh prvided infrmatin n pages 2, 3 & 4) Other adults (eg. grandparents, siblings wh are emplyed r receive Gvernment supprt) Dependent children Children s Frtnightly Centrelink (Yuth Allwance) 1. Child s Name Age: 2. Child s Name Age: 3. Child s Name Age: Amunt Siblings enrlled at ther schl s (ther than Sacred Heart Cllege) Please prvide name, schl, and yearly fees 1. Child s Name: Schl: 2. Child s Name: Schl: 3. Child s Name: Schl: 4. Child s Name: Schl: Yearly Fees 5

6 SECTION 3 Financial Infrmatin (Please nte dcumentatin as described n Pages 2, 3 & 4 must be supplied t supprt figures) Incme Per Week Carer 1 () Carer 2 1. Average weekly earnings (net f tax) 2. Gvernment Supprt 3. Child Supprt/Maintenance 4. Investment Incme 5. Value f any Fringe Benefits 6. Gvernment supprt received by students 16yrs r ver Expenditure Per Week TOTAL INCOME (A) (If carers have jint respnsibility use ne clumn nly) 7. Fd 8. Schl Fees (ther than Sacred Heart) 9. Entertainment/Activities (include any sprts, lessns etc) 10. Clthing 11. Mrtgage/Rent 12. Rates 13. Mtr Vehicle (weekly equivalent fr fuel, repairs, tyres, registratin, insurance) 14. Electricity, Gas 15. Telephne/Internet 16. Insurance (Hme and cntents, life, etc) 17. Health Insurance 18. Medical Expenses 19. Persnal Lans, Hire purchase 20. Credit Cards and Stre Accunts 21. Other Cmmitments TOTAL EXPENSES (B) SURPLUS / (DEFICIT) (A-B) 6

7 Assets and Liabilities Include the ttal value f all items yu wn (assets) and what yu we (liabilities) Carer 1 Carer 2 Assets Family Residence Current Value Other Prperties Current Value Mtr Vehicle/s Bank Accunts Investments (please describe) Other Assets (eg. bat, caravan, etc) TOTAL ASSETS Liabilities Mrtgage Current Balance Carer 1 Carer 2 Mtr Vehicle Lan/s Persnal Lans Other Lans (please describe) Credit Card / Stre Accunts Balance Other Liabilities (please describe) TOTAL LIABILITIES 7

8 SECTION 4 This sectin must be cmpleted fr yur applicatin t be cnsidered Please prvide reasns behind the need fr financial assistance and whether yu see this as a shrt term, r n-ging issue. Please prvide a prpsal fr hw much yu feel yu can affrd t pay: Instalments f Weekly Frtnightly Mnthly Privacy Statement Sacred Heart Cllege Geelng acknwledges that sme f the infrmatin yu are asked t prvide in this Applicatin fr Cncessinal Fees r subsequent additinal infrmatin that may be sught culd be f a persnal r sensitive nature. The infrmatin is used nly t assess this applicatin. Identifying infrmatin is nt prvided t any ther rganisatin except debt cllectin agencies, the Cllege s legal advisrs, r similar rganisatins where debt cllectin recvery actin is instigated by the Cllege. The Cllege is nt aware f any law that requires yu t prvide this infrmatin, hwever shuld yu fail t prvide full and accurate infrmatin the Cllege may nt cnsider yur applicatin. Yu have the right t access any persnal infrmatin that the Cllege hlds abut yu, subject t the exceptins in the Privacy Act 1988 (Cth). Yu may als request the crrectin f infrmatin that is inaccurate. 8