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Dominion Academy

Financial Aid Notice of Intent

Father (guardian):

Home Address:

Zip:

Work Phone:

Home Phone:

Other Phone:


Mother's Name:

Address:

Zip:

Work Phone:

Home Phone:

Other Phone:


Please provide the following information for all school-aged children (5-18) who live with you. List last names if different than yours:

Name:*

Age (as of Sept 30):*

Grade:*

School:*

Relationship to child (choose one):


Name:

Age (as of Sept 30):

Grade:

School:

Relationship to child (choose one):


Name:

Age (as of Sept 30):

Grade:

School:

Relationship to child (choose one):


Name(s) and age(s) of other siblings younger than 5 or older than 18:

Are there other children living elsewhere for whom you have some financial responsibility?

 Yes No

If yes, please explain:


FINANCIAL AID REQUESTED:* $ (This line MUST be completed and contain a dollar amount). Maximum amount possible is 50% of total tuition. Note: This amount should be the TOTAL reduction in annual tuition for all of the children in the family who are enrolled concurrently; families receiving financial aid do not qualify for any additional discounts.

In addition to this form, please complete the online FACTs application to supply income information.

If you have circumstances that would factor in to your financial situation (health-related expenses, single-parent/child support issues, employment in full-time Christian ministry, etc.), please provide a written explanation so that the financial aid committee can consider these factors.