Race/Ethnicity*White/ CaucasianAmerican Indian or Alaskan NativeAsianNative Hawaiian or Other Pacific IslanderBlack or African AmericanHispanic or Latino

Parent/Guardian Information

Parent/Guardian Information*
MarriedDivorcedWidowedSingle
Name(s) of the one(s) financially responsible*

Student Lives With*
Both Parents (married)Both Parents (shared custody)FatherMotherOther

Parent 1

Parent 1 Legal Full Name*

Hebrew Name

Street Address*

City*

State*

Zip Code*

Home Phone

Cell Phone*

Email*

Occupation*

Employer

Work Phone

Employer Address

Parent 2

Parent 2 Legal Full Name

Hebrew Name

Street Address

City

State

Zip Code

Home Phone

Cell Phone

Occupation

Employer

Work Phone

Employer Address

Emergency Contact Information

Name*

Phone*

Financial Information

Does your child qualify for McKay Scholarship?YesNoDon’t Know

Does your child qualify for any of the Step Up For Students Scholarships?
1. FINANCIAL NEEDS BASED YesNoNeed more information
2. FES YesNoNeed more information

Do you need a tuition assistance form sent to you?*YesNo

*Please make sure to hit submit button before you proceed to payment

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