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Sacred Heart Catholic Elementary
10482 LeMoyne Blvd.
D’Iberville, Mississippi 39540
Phone: 228-392-4180 Fax: 228-392-4859
Website: sacredheartelementary.org
Dear Parents/Guardian:
Thank you for considering Sacred Heart Catholic Elementary School for your child’s
education. At Sacred Heart, your child will develop a foundation for life and shine like a
star! Sacred Heart Catholic Elementary shares the responsibility with the parents, the church
and the community to educate the children enabling them to become a mature, responsible
member of society.
Sacred Heart Catholic Elementary is a ministry of Sacred Heart Church and the
Biloxi Diocese, providing an environment allowing each student the opportunity to reach
his/her God-given potential with instruction, discipline and Catholic values which focus on
the formation of a strong moral character, academic excellence, ability to serve others and the
motivation to achieve.
A Catholic education is only one way for your child to reach the ultimate goals of life,
and Sacred Heart Catholic Elementary is only an extension of the education that begins in the
home. Parents/guardians are the primary educators and thus are responsible for providing a
family atmosphere filled with love, respect and desire for what is good and right by
incorporating morals and values. The family provides the learning atmosphere where the
child can develop values and a positive attitude with the love of Christ, and the school
reinforces these characteristics with the academics of an education.
The Sacred Heart Catholic Elementary budget is supported by: tuition,
registration fees, fundraising activities, and supporting parishes. In an effort to balance
financial independence and reasonable tuition rates, we depend on our parents to
participate in the following fundraising events throughout the year which include:
Bingo
“SaveAround” Coupon Books
World’s Finest Chocolate Candy
Sacred Heart 5K Run
Mardi Gras Draw
Golf Tournament
Any other events decided upon through the year
To help plan these events you are encouraged to attend the Family Involvement Teams (FIT)
meetings as scheduled by the Principal. With your support, cooperation and involvement,
your time at Sacred Heart will be appreciated and rewarding not only by you but by the
faculty and staff, the children and the parish family.
Please help our planning efforts, for the 2017-18 school year, by registering your
child before April 30. Again, thank you for considering Sacred Heart Catholic Elementary.
Together we will pray, teach, live, serve and grow in the love of God and each other.
Mr. Richard Lopez, Principal, Sacred Heart Catholic Elementary School
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Acknowledgement and Agreement of Parent Responsibilities
I, __________________________________, have read the welcome letter, and I accept the
responsibility of being a parent at Sacred Heart Catholic Elementary and agree to participate
in the following activities throughout the school year showing my support and helping to
form a foundation for life with morals, values and consideration for others with my child.
1. Maintain a united authority with the school.
2. Be consciously aware of the fact that obedience must first be taught and applied at
home before it can be implemented at school.
3. Have an honest idea of my child’s capabilities. Children are successful if they are
not frustrated into thinking that they are expected to perform at a higher level than
their ability allows or if they are not challenged to meet their highest potential.
4. Reinforce the teaching of respect for others and the property of others.
5. Encourage your child to develop good study habits.
6. Monitor your child’s television viewing both in time and content of programs.
Encourage active participation in family activities. In addition, monitor your
child’s use of the computer and telephone.
7. Provide a good Christian example for your child, through family prayer and
regular attendance at Mass as a family. Use proper language at all times and
practice Christian examples for your child to observe.
8. Supervise homework letting your child do his/her work unless you see that the
work is being done improperly.
9. Participate with the Family Involvement Teams (FIT), which meets on the first
Thursday of each month.
10. Bingo - Work 4 Sunday night’s out of the year.
11. Bazaar – October (work two hours during the weekend event).
12. Drawdown February (purchase two tickets totaling $80.00 at registration, sell
two tickets by December and volunteer to prepare for the event).
13. Participate in all other fundraising activities:
SaveAround Coupon Books
World’s Finest Chocolate Candy
Sacred Heart 5K Run
Mardi Gras Draw
Golf Tournament
Any other events decided upon through the year
_______________________________________ _____________________________
Parent’s Signature Date
_______________________________________
Print Name
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Sacred Heart Catholic Elementary
Registration Requirements
And Tuition Options
You must submit the registration packet and fee to be considered registered.
Required Forms at Registration
Must be provided by each new student:
Birth Certificate
Social Security Card
Immunization Compliance Form 121
If Catholic, a Baptismal Certificate
Required Fees at Registration
A registration fee of $370.00 per child is due at the time of registration.
Each family is required to purchase 2 Mardi Gras Draw tickets for $40.00 each
totaling $80.00.
Total amount due at registration is $450.00
(If the family has more than one child half of the fee is due at registration and the
other half is due by May 1, of the prior year you are applying for acceptance.)
The Registration fee includes the following fees:
$100.00 for Books
o (snack fee for preschool students instead of books)
$15.00 for Superintendent’s fees
$15.00 student insurance
$15.00 for Power School
o (An online parent’s access to student assignment and grade book)
$15.00 for School Messenger phone and email emergency services
$10.00 for Special Class supplies (Art, Music, Spanish and P.E.)
$25.00 for playground repairs
$25.00 for teaching supplies
$25.00 library supplies
$75.00 for Technology
$50.00 for Fieldtrips
$80.00 2 Mardi Gras Draw tickets
The Registration fee and Mardi Gras Draw tickets are Non-Refundable
Tuition Payment Options:
One time payment in full by August 1
Two payments in full
First payment due by August 1
st
and Second payment due January 1
st
10 Monthly Payments
The first tuition payment is due August 1
st
and the last payment is due May 1
st
Families receiving the Needs Based Tuition Assistance only qualify for the 10-month
payment plan through First Bank and Trust.
A late fee of $30.00 will be charged to each account paid after the 10
th
of each month
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Sacred Heart Catholic Elementary School
Tuition Rates 2017-2018
Elementary (Kindergarten – 6
th
grades)
Parish Affiliated with One Child 3,900.00
Parish Affiliated with Two Children 6,100.00
Parish Affiliated with Three Children or more 7,900.00
Non-Parish Affiliated with One Child 5,000.00
Non-Parish Affiliated with Two Children 7,350.00
Non-Parish Affiliated with Three Children or more 9,525.00
Multiple students add additional $250.00 for each preschool child
Preschool Only (3 & 4 year olds)
Parish Affiliated per preschool child 4,150.00
Non Parish Affiliated preschool child 5,250.00
Families with children in elementary and preschool will have an additional $250.00
charge for each preschool student.
For instance, a family with one 1
st
grade student and one PK student paying the parish
affiliated rate would pay $6,350.00.
Parish Affiliated means that you are a registered member of one of the parishes in the Biloxi
Diocese and are actively using the envelopes for donations to that parish. The Pastor of the
parish you are a member of must complete a Parish Affiliation Form to receive the parish
affiliated tuition rate.
A Non-Parish Affiliation means you are not a member of any parish within the Diocese of
Biloxi or you do not have a letter from your parish pastor stating your affiliation with that
parish.
Needs Base Tuition Assistant and Scholarship Packets are available in the school office
upon request. No application will be processed without the $50.00 processing fee. The
deadline for submitting tuition assistance packets is May 1, 2017. Individual families
receiving the needs based tuition assistance only qualify for the 10-month payment plan with
a loan from First Bank and Trust.
Additional fees:
Extended Care – $3.00 an hour
Morning care begins at 6:30 a.m. to 7:30 a.m.
Extended Care hours are from 3:15 p.m. until 5:30 p.m.
Extended Care services will be billed at $3.00 an hour.
All remaining students after dismissal will go directly to
Extended Care.
There will be an additional $10.00 late fee for each 10-minute
interval after 5:30 p.m., per child.
Lunch - $3.75 a meal (Sacred Heart does not serve breakfast, only lunch)
Fundraising Supplies – (donations for items used during fundraising events)
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Sacred Heart Catholic Elementary
Tuition Assistance Criteria and Procedure
All Parishes in the Biloxi Diocese provide tuition assistance to their parishioners who are in
need of assistance and attend a Catholic school in the Biloxi Diocese. Scholarships are
available when funds are available from Sacred Heart Parish collections and private
donations.
Sacred Heart Parish offers tuition assistance and if available scholarships to the students in
Pre-K through 6
th
grades for parishioners of Sacred Heart Parish and students attending St
Patrick High School. Families registered at parishes other than Sacred Heart must seek
assistance from their respective parish.
Any family in need of tuition assistance or a scholarship must complete and submit a tuition
assistance and loan application form from First Bank and Trust by May 1, of the prior school
year for which the application is for and provide a $50.00 processing fee to be paid to First
Bank and Trust. Returning families must participate in four or more fundraising events in the
prior year to qualify for the needs based tuition assistance. Applications are available in the
office upon request.
First Bank and Trust will process the information and report each applicant’s individual
needs to the school. Once the school receives the report from First Bank and Trust, the
report is reviewed by TARC (Tuition Assistance Review Committee). After reviewing the
report and completing the TARC Applicant Information Form, the report, form and TARC
Committee’s recommendations will be forwarded to the pastor of Sacred Heart Parish. The
pastor of Sacred Heart Parish will review the report with the TARC recommendation and
distribute the tuition assistance and or scholarships according to the applicant’s needs and
available funds. Returning students will receive first priority for funding.
Needs Based Tuition Assistant / Scholarship and Loan Packets are available in the school
office upon request. No application will be processed without the $50.00 processing fee.
The deadline for submitting a tuition assistance and scholarship packet is May 1, 2017.
Individual families receiving the needs based tuition assistance only qualify for the 10-month
payment plan with a loan from First Bank and Trust.
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Family Information Form
Students Names: _________________________, ______________________________,
_________________________, ______________________________
Family Religion: ________________ Parish/Church Affiliation: _________________
Name of Individual completing registration forms: ______________________________
Relationship to student: ____________________________________________________
If you are the guardian, please attach copy of Guardianship Decree.
Parents Marital Status: _____Married _____Divorced _____Single Parent
Please circle the appropriate title for each section.
Mother/Guardian
Name_____________________________________________________
Address ___________________________________________________
City _______________ State _________________ Zip Code _________
County ____________________________________________________
Home Phone ______________________ Cell Phone _______________
Employer ________________________ Work Phone ______________
E-mail Address ______________________________________________
Step Parent Name ____________________ Phone No. _____________
(If Applicable)
Father/Guardian
Name_____________________________________________________
Address ___________________________________________________
City _______________ State _________________ Zip Code _________
County ____________________________________________________
Home Phone ______________________ Cell Phone _______________
Employer _________________________ Work Phone _____________
E-mail Address______________________________________________
Step Parent Name ____________________ Phone No. ______________
(If Applicable)
Telephone number to be used to send School Messenger System messages:
_______________________________________________________________
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Student Name: ________________________________________________________
EMERGENCY CONTACT
In the event of an emergency and I am not available, a Sacred Heart Catholic Elementary
employee has my permission to contact the following individuals to assist and, if need be,
release my child to their care.
Contact #1 Name _______________________ Relationship ___________________
Home Phone _________________ Cell Phone _____________________
Contact #2 Name _______________________ Relationship ___________________
Home Phone _________________ Cell Phone ____________________
Contact #3 Name _______________________ Relationship ___________________
Home Phone _________________ Cell Phone _____________________
Contact #4 Name _______________________ Relationship ___________________
Home Phone _________________ Cell Phone _____________________
Contact #5 Name _______________________ Relationship ___________________
Home Phone _________________ Cell Phone ___________________
My child may not be released to the care of the following individuals: ______________
__________________________________________________________________________
MEDICAL INFORMATION
Immunization Certification Form No. 121 up to date and on file: ___Yes ___No
Family Doctor: ______________________________ Phone No. _____________________
Preferred Hospital: __________________________________________________________
Medical History/Special Medical Conditions:
Please list and explain: ________________________________________________________
Please list all Allergies: _______________________________________________________
Please list all Current Medications: _____________________________________________
___________________________________________________________________________
Parent/Guardian Signature _________________ Date _________________________
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MORNING AND AFTER SCHOOL CARE PROGRAM
Morning Care Hours and Rates
After School Care Hours and Rates
Children not picked up by 3:15 p.m. will be sent to After School Care.
Children must be picked up by 5:30 p.m. If your child is picked up after 5:30 p.m., you will
be assessed a fee of $10 per each 10 minute-interval until the child is picked up.
Please mark yes or no determining your child’s participation in:
Morning Care Yes__ No__
After School Care Yes__ No__
Please mark the days your child will be attending the Extended Care Program:
Morning Care
___ Monday ___ Tuesday ___ Wednesday ____ Thursday ___ Friday ___Occasionally
Afterschool Extended Care
___ Monday ___ Tuesday ___ Wednesday ____ Thursday ___ Friday ___Occasionally
Statements are sent home each Monday with the children. Morning and After School Care
charges must be paid within 30 days or students will be denied participating in the program
and a parent or guardian will be called for the student(s).
Hours Rates
6:30 a.m. to 7:30 a.m. $3 - Drop Off before 7:30 a.m.
Hours Rates
3:15 p.m. to 4:30 p.m. $3 Pick - Up before 4:30 a.m.
4:30 p.m to 5:30 p.m. $6 Pick - Up before 5:30 p.m.
After 5:30 p.m. $10 per each 10 minute-interval
until child is picked up
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STUDENT INFORMATION
First Name _______________________ Middle Initial _____ Last Name ____________
Grade (upcoming school year) ________ Student goes by ______________________
Birth Date _________________________ Social Security No ___________________
Race ______________________________ Gender ____________________________
Student lives with: Parents Mother Father Grandparent Other Guardian
Guardianship with: Mother Father Grandparent Other Guardian
Sacramental Data Date Church Priest
Baptism
Reconciliation
Eucharist
Has the student ever been the subject of, or threatened with, expulsion, suspension,
alternative schooling or similar disciplinary measures? ______ Yes ______ No
If yes, explain: ___________________________________________________________
Has the student ever been charged with any crime? ______ Yes ______ No
If yes, explain: ___________________________________________________________
Students Past School Record
If transferring from another school, please complete the following information:
Sacred Heart Catholic Elementary School has my permission to request my child’s records.
Name of School last attended: _______________________________________________
Address: _____________________________________ Phone No. _________________
List of School Attended Town or City, State School Year Grade
Years in each Grade
Parent/Guardian Signature ___________________ Date _______________________
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Sacred Heart Catholic Elementary
Diocese of Biloxi
Department of Education
Family/Student Registration
Misrepresentations:
The education of students at Sacred Heart Catholic Elementary School is based upon an
agreement between the school and parents. The School agrees to provide educational services
in exchange for the parents’ payment of tuition/costs and their promise to abide by policies,
procedures and rules of the school. The information provided on this form induces the school
to enter into this agreement and, therefore, ANY MISREPRESENTATION, INACCURACY OR
UNTRUTH IN THE INFORMATION PROVIDED HEREIN,WHEN DISCOVERED, MAY BE GROUNDS, IN
THE SOLE DISCRETION OF THE SCHOOL, FOR SUSEQUENT REMOVAL OF THE STUDENT(S) FROM
THE SCHOOL AND THE TERMINATION OF THIS AGREEMENT.
Education of children with special needs:
Consistent with the Gospel, Catholic Schools do not discriminate and believe that all children
would benefit from an educational experience that includes the teaching of religious and moral
values. In reality, however, due to limited financial resources Catholic schools are not able to
effectively provide appropriate educational programs for all students. Some students require
certain educational program modifications and resources that we are not able to provide within
our schools. The law recognizes this in the fact that while public schools must make a
“reasonable accommodation” to educate all students, we are called upon to make ONLY “minor
adjustments” to our educational program for those students who would otherwise be qualified
for admission. If your child has special needs, you are free to request a program for those
students who would otherwise be qualified for admission. If your child has special needs, you
are free to request a program modification on the attached form. Provided that your child is
otherwise qualified for admission, if the required program modification constitutes “minor
adjustment” the child may be admitted; however, if more than a “minor adjustment” is needed,
then the child would be better served by an institution equipped to serve that particular need.
ANY TIME IT BECOMES APPARENT THAT A CHILD REQUIRES MORE THAN “MINOR
ADJUSTMENTS” TO BE EFFECTIVELY EDUCATED, THE SCHOOL RESERVES THE RIGHT TO MAKE
THIS KNOWN TO THE PARENTS ALONG WITH THE FACT THAT THE CHILD’S EDUCATIONAL
NEEDS COULD BE BETTER SERVED ELSEWHERE.
Student Name ______________________________________________________________________________
With regard to the school’s educational program, if you would like to request any
program modifications or accommodations or make known any special needs, you may
do so here:
Has your child participated in: _______ Speech ______ Title I Tutoring _______ Other
If other, please explain: ____________________________________________________________________
_______________________________________________________ ____________________________________
Parent/Guardian Signature Date
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Permission to Publish Photographs on Website and Newspaper Articles
(Authorization to disseminate and utilize information and wavier a remuneration and of liability)
I hereby grant Sacred Heart Catholic Elementary the right to obtain, disseminate and utilize
the following listed information pertaining to my child/children:
(List students’ names here)____________________________________________________
Without cost, remuneration, royalty fee or expense, on its website, in the print media, in
school publications, on the radio or on television programs and without further notice:
1. Photographic images, video images or similar technology which may effect a
visual representation of my child/children including candid images
taken during school hours and/or at school functions;
2. Audio or digitally reproduced, taped and other vocal reproductions and
representations of any child/children’s voice;
3. Honor Roll list containing my child/children’s name in conjunction therewith;
4. Citizenship, religious and other awards received by child/children as judged
appropriate for inclusion;
5. Samples of child/children’s work (ex: art, essays, etc.);
6. School newsletter or school publications with any reference made to my
child/children or his/her class activities.
I understand that no photographic or visual reproduction of my child appearing on the
school’s website/home page will identify my child/children by name. My child/children,
however may be identified by name in other media representations. I understand that all
images, reproductions, content or other information which is not hereby authorized to be
appropriately utilized shall become the property of Sacred Heart Catholic Elementary School,
to be used as deemed appropriate in its sole discretion, without royalty payments, fees or
remuneration of any kind.
Further, I waive and release any claims for damages or liability against Sacred Heart
Catholic Elementary School, its related parishes or the Catholic Diocese of Biloxi, which I
may now have or have in the future, arising out of in anyway connected with the production,
use and dissemination of the above authorized information on my child/children upon the
aforementioned media sources.
(Please check one of the following statements)
___ I do wish to grant Sacred Heart Catholic Elementary School the right to obtain,
disseminate and/or utilize the above information pertaining to my child/children.
___ I do not wish to grant Sacred Heart Catholic Elementary School the right to obtain,
disseminate and/or utilize the above information pertaining to my child/children.
______________________________________ ____________________________
Parent/Guardian Signature Date
______________________________________
Print Name
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Sacred Heart Catholic Elementary School
Procedure for Internet Access
Sacred Heart Catholic Elementary School provides access to the Internet for all students, faculty and staff.
Students must have permission from at least one of their parents/guardian to access the Internet at school. Any
use of the Internet at Sacred Heart Catholic Elementary must comply with the philosophy and rules of discipline
already in place as outlined in the Student/Teacher Handbook as well as all policies and procedures, and any
infraction of these rules while accessing the Internet will be dealt with as with any other infractions. The use of
the Internet is a privilege, not a right, and inappropriate use will result in disciplinary action by school officials
and/or the cancellation of those privileges. Each user who is provided access to Internet and related
technologies will participate in a discussion with assigned staff persons concerning proper use of the network.
A student’s activities while using the Internet
in this school must be in support of education and research, and consistent with the educational objectives of
Sacred Heart Catholic Elementary School. Such constitutes “acceptable use” under this policy. In addition, a
student accessing the Internet from a school site is responsible for all online activities that take place through
the use of the access line. Students are required to have teacher supervision when accessing information.
Actions which constitute “unacceptable use” and, therefore, violate this policy, include by the way of
illustration, but will not be limited to the following:
1. Using impolite, abusive, or otherwise objectionable language in messages;
2. Placing unlawful information on the Internet;
3. Using the Internet illegally in ways that violate federal, international, state or local laws or treaties;
4. Using the Internet at school for non-school related activities;
5. Sending messages or data that is likely to result in the loss of the recipients work, data and/or hardware
or software;
6. Sending chain letters, flame letters, etc., or pyramid schemes to lists or individuals, and other types of
use that would cause congestion of the Internet or otherwise interfere with the work of others
7. Using the Internet for advertising or commercial purposes;
8. Using the Internet for political lobbying;
9. Sending or receiving copyrighted materials or materials protected by trade secret without the owner’s
permission;
10. Knowingly giving one’s (school’s) password to others;
11. Using another person’s password;
12. Using Internet access for sending or retrieving pornographic, threatening or violent material, such as
information on bombs, and/or inappropriate text files, or files dangerous to the integrity of the
network;
13. Circumventing security measures on school or remote computers or networks;
14. Attempting to gain improper access to another’s resources, programs, or data; copy of most current
Diocesan Policy Book.
15. Vandalizing, which includes any malicious attempt to harm or destroy data of another user on the
Internet, and also including the uploading or creation of computer viruses;
16. Revealing one’s name, address, phone number or any personal information to any person or indentity
on the system (with a requirement to immediately disconnect and inform a faculty member should
anyone request this information of you);
17. Falsifying one’s identity to others while using the Internet;
18. Changing any computer fields that do not belong to the user.
It is understood that any e-mail received through the online access at the school will not be considered
private and will be read by a staff member. No student should solicit e-mail personally. Parents will not
send email to individual students. Any messages that are inappropriate use will be reported. Use of any
information obtained via the Internet and related technologies are at the users own risk. The educational
programs governed by the school specifically deny any responsibility for the accuracy or quality of
information obtained and makes no warranty with respect thereto or costs incurred thereby.
All students who will be using the Internet at Sacred Heart Catholic Elementary School and at least one of
the parents/guardians of each student, shall sign and return the form on the back before the student is
allowed to participate in use of the Internet.
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STUDENTS AND PARENT’S AGREEMENT ON USE OF THE INTERNET Page 2
We/I have read the policy on Acceptable Use of the Internet Access at Sacred Heart Catholic Elementary
School and my child and I understand and agree to abide by the principles and guidelines contained therein.
As the student, I agree that should I encounter or become aware of any misuse of Internet access, I will
immediately inform the Principal, teacher or staff member about same. As the parent/guardian, I hereby
give my permission for my child to access the Internet at the school with the supervision of the faculty
and/or staff. In addition, we, both student and parent/guardian, agree that we have read and shall refrain
from those actions referred to in the policy which are considered unacceptable to the proper use of Internet
resources.
___________________________________ ________________________________
Student’s Signature Parent/Guardian Signature
___________________________________
Date
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Sacred Heart Catholic Elementary Home Language Survey/Referral
For Harrison County School District
2017-2018
Student Name (Print) ___________________________________________________
First Middle Last
Teacher ___________ School __________ Grade ____ DOB _______ MSIS# _____
1. What language did the student first learn to speak?
___ English
___ Other _______________________________
2. Does this student routinely speak or use a language in the home other than English?
___Yes
___ No
If you checked “yes”, please explain __________________________________
3. Does the student live in a home with a parent or guardian who primarily uses a
language other than English?
___ Yes
___ No
If you checked “yes”, please explain ________________________________
4. Does the student have a parent or guardian who requests or requires communication
with the school district in a language other than English?
___ Yes
___ No
If you checked “yes”, please explain _________________________________
This form will be included in the student’s permanent record. ANY indication that there is
language other than English may result in the student being assessed for English language
proficiency. Parent(s) or guardian(s) will be notified prior to placement. This form must be
returned to the ELL Coordinator within 3 school days of enrollment.
Review for assessment will occur within 10 days of enrollment or identification by the
school.
***School officials should complete this form for any student they believe may be ESL,
regardless of whether the parent returns/submits it.
Parent/Guardian Signature __________________________ Date _________________
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Parish Affiliation Form
Please check the Parish you are affiliated with and print your name and your child/children’s
name. If you are a member of Sacred Heart Parish you may return this form completed to the
school office and a school official will deliver the form to the Pastor for his approval. If you
are not a member of Sacred Heart Parish, please take this form to your pastor to complete and
return it to the school office. You will be informed of your financial status once all
information is returned to the school office.
_______ I am affiliated with Sacred Heart Parish, D’Iberville
_______ I am affiliated with St. Mary’s Parish, Woolmarket
_______ I am affiliated with Holy Spirit/Christ the King, Vancleave/Latimar
_______ I am affiliated with ___________________ Parish in _____________________
Parents’ Names: __________________________________________________________
Student Names: Grade
_____________________ ______
_____________________ ______
_____________________ ______
_____________________ ______
Dear Pastor:
By signing this form you are stating that the above family is a member of your parish and
qualifies for the subsidy tuition rate. The subsidy tuition rate is more that $1,100.00
difference from a non-parish family. We would appreciate your parish providing Sacred
Heart Elementary the difference for the subsidy rate as Sacred Heart Parish does for the
parishioners of its parish.
I have verified that the above named family is a member of _______________________
Parish.
____________________________________ ___________________________
Pastor’s Signature Date
Will your parish subsidize the $1,100.00 difference for the above named family.
_____ Yes ______ No
Does this family qualify for an additional Needs Based Tuition Assistance?
_____ Yes ______ No
If yes, what is the amount that your parish will pay for the above named family tuition
assistance? $______________