Online Flexible Tuition Form

Parent/Guardian #1*
First Last
Address*
Street Address City State ZIP Code
Home Phone
Cell Phone*
Email*
Parent/Guardian #2
First Last
Address
Street Address City State ZIP Code
Home Phone
Cell Phone
Email
List All Children: Name/Age/Gender*
2020 Income and Expenses
Please answer the following questions fully to provide an accurate and complete picture of your present financial position. You will be asked to provide tax returns and other documentation as part of the review process. The fairness and success of our financial assistance program depends on your full and candid response to the following questions.
Salary: Parent/Guardian #1*
Salary: Parent/Guardian #2*
Interest & dividend income*
Other income*
Total monthly rent or mortgage*
This is rent or mortgage paid on your residence only. Do not include payments on property held for rental purposes. Do not include real estate taxes or insurance.
Real estate taxes paid in 2020*
Please provide real estate taxes paid on your residence only. Do not include taxes paid on property held for rental purposes.
State income taxes paid in 2020*
Enter the amount from line 64 of your 2020 Form 540. If you haven't completed your return please use the amount from your 2020 W2 or the year to date amount from your year-end 2020 pay stub.
Federal income taxes paid in 2020*
Enter the amount from line 24 of your 2020 Form 1040. If you haven't completed your return please use the amount from your 2020 W2 or the year to date amount from your year-end 2020 pay stub.
Total amount of other large expenses*
Please provide details of other large expenses*
Will your tuition be paid from any other source? If yes, please specify.*
Assets & Liabilities
Approximate value of real estate owned and date purchased*
Approximate amount of loans against real estate*
Current principal balance
Total amount of savings accounts*
Total value of stock & bond portfolios and other asset accounts*
Please do not include retirement accounts
Total household debt*
Please itemize. Examples: vehicle loans, personal loans, student loans, credit card debt
Please provide any other information that would help us evaluate your application for tuition assistance in the box below. Also, please let us know if you anticipate any significant changes in your financial position in the upcoming year.
Please submit your 2020 tax return to the CCJDS Business Office to be reviewed with your application. If your 2020 return is not completed, please provide your 2019 return and your 2020 W2 or 2020 year-end pay stub. Once you have completed your 2020 return, please provide a copy. Your financial assistance is subject to change based on this information. Please note in the box below when the documents will be sent.*
Tax returns and other documents can be emailed to businessmanager@ccjds.org or mailed/dropped off at CCJDS Business Office 955 Risa Rd. Lafayette CA 94549
Electronic Signature*
- I accept
Please check the box in lieu of a written signature.
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2020 Income and Expenses

Assets & Liabilities

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