St. John’s Ev. Lutheran School - Printable Form 

42685 County Road 12 - Nodine; Dakota, MN 55925

Tuition assistance is available to all students of St. John's.  Please fill out the

form below and submit it to Mr. Kutz by June 1, 2008.   Contributions to the

Tuition Asssitance Fund are welcome throughout the year.

Tuition Assistance Application

Date ___________________                     School Year _____________________

Parents’ Names ______________________________________________________

 Address  ____________________________________________________________

 Student name(s) and Grade _____________________________________________                                          

         _______________________________________________________________                                                            

       ________________________________________________________________       

Sibling’s names and ages ______________________________________________

                ___________________________________________________________ 

1)      Briefly describe your current circumstances and any financial information that will assist the

Youth Discipleship Committee in evaluating this request.  Your privacy will be maintained.

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

2)      Amount of tuition assistance requested  $____________________________________

3)      The above information is accurate and complete.            

Parent(s) Signature                  

_____________________________________                  ___________________________________

Please return application to St. John’s School office by June 1, 2008

Your application will be reviewed by the Youth Discipleship Committee and you will be contacted after the June meeting.

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Amount Approved $___________________            Date _____________________

Signed (Youth Discipleship Chairman)  _______________________________________________