SPECIAL CIRCUMSTANCES APPLICATION

SPECIAL CIRCUMSTANCES APPLICATION

Lima Christian School Special Circumstances Fund FAQ Answer: Answer: Who can apply for Special Circumstance Funds? Anyone who is in need of tuition assistance due to family financial limitations. How are Special Circumstance funds appropriated? SCF fund appropriation is determined based on the SCF Applications which are used to compute the Effective Family Contribution. A committee reviews all the applications and appropriates funds according to need and special circumstances. Last year I received Special Circumstance Funding assistance to help pay my tuition. Do I need to re-apply for SCF funding for the upcoming school year? Answer: Yes, To receive SCF funds to assist with your tuition payments you must re-apply each school year. Applications need to be submitted no later than June 20th of the current school year. What do I need to do to apply for Special Circumstances funding? Answer: Complete he SCF application form for upcoming school year. Each family that would like financial assistance for the upcoming school year must complete this application form. Forms are available online. When will I know if I have qualified for SCF funding? Answer: Hopefully, we will be able to notify you no later than July 31 st. Answer: Do I need to do anything to verify my family s income? You must submit a copy of your most recent 1040 tax form if you file taxes. A W-2 is not acceptable. If you receive public assistance or do not file taxes for other reasons, submit a copy of your public assistance statements or other proof of income and get your Financial Information Form(C-2) notarized. Who should I call if I have questions on the Application Form? Answer: You can call the Principal at 624-3841.

***COMPLETE ONLY IF YOU DID NOT FILE A TAX RETURN IN PREVIOUS YEAR*** Lima Christian School Special Circumstances Fund Family Application in Form C 2 Financial Information: All parents and/or guardians who claim S.C. Fund recipients as dependents must report income on the form with supporting documentation. Head of Household Name: First Name Middle Initial Last Name Number of people in household: Adults Children_ Please list children in your household applying for S.C. funds. Children s Names/Grade in Sept 08: Income Source Father Mother Other AFDC or ADC Other Public Assistance Any Other Additional Income Total Household Income (Sum of Row) Total Individual Income ***To verify income please attach to this application supporting proof of income. I certify that all the information provided on this application is true and complete to the best of my knowledge. I agree to provide proof that the statements made in this application are true and I acknowledge that failure to do so will invalidate the S.C. funding.

Form C- 2 Continued _ Print Name of Parent of Guardian Signature of Parent or Guardian Date _ Print Name of Parent of Guardian Signature of Parent or Guardian Date (over) Complete this section only if you do not file a 1040 (Parents/guardians using a notary must also provide supporting financial information). I certify that this applicant has provided me or this notary service with adequate proof of income and that to my knowledge the financial information provided on this form is true and complete. Notary Signature Date Notary Name Printed Notary Stamp

Special Circumstance Application Family Information: Head of Household Name: Phone No/Email address: Is a parent employed in a ministry capacity or attend a Christian College? Yes No The number in family is the family size, including the student. It should include the number of people in the household that will get more than half their support during the award year from the household. Support includes money, gifts, loans, housing, food, clothes, car, medical and dental care, payment of college costs, and so on. Household Size (Number in Family): Number students attending LCS: Parent Information: If the parents are divorced, list only the income and assets for the custodial parent in the parent information section. If the custodial parent has remarried, however, also include the financial information for the stepparent. The following questions ask whether the parents were eligible to file one of the simpler tax forms, not which form was actually filed. Were your parents required to file a tax return during the tax year prior to this current year? Yes (Provide copy of 1040 only) No (Please complete Form C-2 attached & have it notarized) Regardless of your answer please continue with this application form If your parents filed a tax return, were they eligible to file an IRS Form 1040A, 1040EZ, or 1040TEL? Yes No If one of the parents is deceased and the living parent has not remarried, indicate the number of parents as One. Number of Parents: One Two When filling in the State of Legal Residence please use the appropriate two-letter state abbreviation. State of Legal Residence: Age of Older Parent:

Special Circumstance Application Parent Information: (continued) Parents should include only those figures that were reported on their income tax return. Adjusted Gross Income (AGI): (Form 1040, Line 37) Federal Tax Paid :(Form 1040 Line 46) If you leave the Federal Tax Paid field blank, it will compute an estimate based on the Adjusted Gross Income. To specify zero tax paid, enter a 0 in the field instead of leaving it blank. Earned Income (Father/Stepfather): (See Explanation Attached) Earned Income (Mother/Stepmother): Worksheet A (Untaxed Benefits): (See Detailed Worksheet and Explanation Attached) Worksheet B (Tax-Deferred & Untaxed Income) (See Detailed Worksheet and Explanation Attached) Worksheet C (Student Aid Included in AGI): (See Detailed Worksheet and Explanation Attached) Liquid Assets (Cash, Savings, Checking): Net Worth Business or Farm: (See Explanation Attached) Other Investments (See Explanation Attached)

Special Circumstance Application Student(s) Information: The following questions ask whether any of the students were eligible to file one of the simpler tax forms, not which form was actually filed. Were you (a student) required to file a tax return during the tax year prior to the award year? Yes No If you (a student) filed a tax return, were you eligible to file an IRS Form 1040A, 1040EZ, or 1040TEL? Yes No Students should include only those figures that were reported on their income tax return. (Combine all the income reported for students included in this application) Adjusted Gross Income (AGI): Federal Tax Paid: Earned Income (Student s): Worksheet A (Untaxed Benefits): Worksheet B (Tax-Deferred & Untaxed Income) Worksheet C (Student Aid Included in AGI): Liquid Assets (Cash, Savings, Checking): Net Worth Business or Farm: Other Investments Students Names/Grade in Sept 08(only students applying for SCF Funds)

Special Circumstance Application Are there any extenuating circumstances you would like to share that would not be reflected in your financial information?

Special Circumstance Application EXPLANATIONS: Income Earned from Work This is your salary, wages, tips and combat pay. This figure is used to calculate the FICA tax allowance and Employment Expense Allowance, so be sure to include both this figure and the AGI figure on the Special Circumstance Application form. An accurate number can be obtained by adding Box 5 from your W-2 statements to either line A.4 or B.6 of Schedule SE (if you were self-employed). Worksheet A (Untaxed Benefits) reports benefits that were not included in taxable income but which are counted during the need analysis process. These amounts will be added to taxable income. This includes the following: Earned Income Credit (EIC) Additional child tax credit Welfare Benefits, including Temporary Assistance for Needy Families (TANF). Do not include food stamps or subsidized housing. Untaxed Social Security benefits. Worksheet B (Tax-Deferred and Untaxed Income) reports income that was not included in taxable income but which are counted during the need analysis process. These amounts will be added to taxable income. This includes the following: Contributions to tax-deferred pension and savings plans. IRA deductions and payments to SEP, SIMPLE and Keogh plans. Child support received for all children. Do not include foster care or adoption payments. Tax-exempt interest income. Untaxed portions of IRA distributions and pensions, excluding rollovers. Housing, food and living allowances paid to members of the military, clergy, and others. Veterans non-education benefits such as Disability, Death Pension, Dependency & Indemnity Compensation (DIC), and VA Educational Work-Study allowances. Any other untaxed income or benefits not reported elsewhere on Worksheets A or B, such as worker s compensation, untaxed portions of railroad retirement benefits, Black Lung Benefits, disability, and so on. Worksheet C (Student Aid Included in AGI) reports certain types of taxable student aid income and credits that were included in AGI but which are not counted during the need analysis process. These amounts will be subtracted from taxable income, thereby increasing aid eligibility. This includes the following: Education credits (Hope and Lifetime Learning Tax Credits). Child Support paid because of divorce or separation (do not include support for children included in the student s parents household, as reported in the Number in Household question). Taxable earnings from Federal Work-Study and other need-based work programs. Include the need based employment portions of fellowships and assistantships. Other student grant and scholarship aid reported in adjusted gross income (AGI). This includes AmeriCorps awards (awards, living allowances, and interest accrual payments), as well as student grants and scholarships (only the amount that is taxable and was included in AGI, such as the amount in excess of qualified higher education expenses)

Liquid Assets Liquid assets include cash, savings accounts and checking accounts. Net Worth Business and/or Farm Net Worth from Business and/or Farm value includes the market value of land, buildings, machines, equipment, inventory, etc. Business and/or investment farm debt means only those debts for which the business or investment farm was used as collateral. Do not use the value of a family farm that you (your spouse and/or students parents) live on and operate. Do not include the value of a small business that you own and control and that has 100 or fewer full-time or full-time equivalent employees. Investments Investments include real estate (not your home), trust funds, UGMA and UTMA accounts, money market funds, mutual funds, certificate of deposits, stocks, stock options, bonds, other securities, Coverdell savings accounts, 529 college savings plans, the refund value of 529 prepaid tuition plans, installment and land sale contracts (including mortgages held), commodities, etc. Investment value means the current balance or market value of these investments as of today. Investment debt means only those debt that are related to the investments. Investments do not include the home you live in, the value of life insurance, retirement plans (pension funds, annuities, non-education IRA s, Keogh plans, etc.) or cash, savings and checking accounts already reported in Liquid Assets section. Certificates of Deposit (CDs): Money Market Funds: Mutual Funds: Stocks: Bonds: Tax-exempt Bonds: Trust Funds: Real estate (do not include the family s primary residence): Custodial account (UGMA or UTMA): 529 Plan: Educational IRA: Other Assets: Total Investments $