Fee Assistance Application Form
Please download this form and mail to:
4R's Education Centre (Soc.)
581 McPhee Avenue
Courtenay, BC V9N 2Z7
Fee Assistance Information
Fee Assistance money is raised by the ongoing efforts of 4R's staff, Board members, parents and volunteers. Currently, due to limited funds, there is an upper ceiling of $3,000.00 per student available. We require parents/guardians to assist in these fund raising efforts by volunteering 20 hours per school year per registered student. A checque for $200.00 per student (post-dated to the end of the school year) is required as a deposit - towards these hours. SHould allocated volunteer hours not be completed, cheques will be cashed at the end of June.
If you have any questions regarding eligibility, please contact the office at (250) 338-4890.
Tear off and return agreement below
Commitment Agreement
An initial three of four month commitment - depending on the number of lessons per weeek - (36-42 hours) is required. Classes will continue for the agreed time as long as:
- the student shows good attitude and effort
- the student shows reasonable progress
- the student attends classes regularly
- the parent or guardian makes payments for tuition on time
I understand the above conditions and that I have been approved for Fee Assistance for _____________________________ (child's name), for an initial three months (30 - 36 hours), leaving me to pay $__________ per month. This I agree to do. I also agree to inform my child of the importance of good attitude, effort, progress and regular attendance and make every effort to support him/her in this.
| Signed: | ______________________________ |
| Print Name: | ______________________________ |
| Date: | ______________________________ |
Application for Fee Assistance
The 4R's Education Centre (Soc.), a non-profit organization, offers limited Fee Assistance to those who are unable to manage the full cost of individualized teaching. The amount available in the Fund varies and is allocated on 'need' basis, according to demand and family circumstances. The Fund depends entirely upon donations, Gaming funds, and on various fund-raising events during the year. All parents are asked to become members of the Society and asked to give assistance at fund-raising events but if you receive assistance you, or a person you designate in your stead, will be required to help out with these events. Your co-operation is requested when you receive a call for help.
The Finance Committee reviews applications every three to four months to ascertain need for assistance in order that a student may come/continue coming for help.
Please be aware that we cannot supply full fees for any student due to our limited resources. The amount available per month may vary according to the amount available for disbursement.
Please answer the following questions to the best of your ability.
This information will be kept confidential and only reviewed by the Fee Assistance Committee.
Name by which the child is known: _____________________________________________
Name and ages of all other dependents: _____________________________________________
| Father/Guardian | Mother/Guardian | |
|---|---|---|
| Name: | ______________________________ | ______________________________ |
| Mailing Address: | ______________________________ | ______________________________ |
| Postal Code: | ______________________________ | ______________________________ |
| Phone: | ______________________________ | ______________________________ |
| Employer: | ______________________________ | ______________________________ |
| Employer's Phone: | ______________________________ | ______________________________ |
| Full or Part time? | ______________________________ | ______________________________ |
| Average hours/week if part time: | ______________________________ | ______________________________ |
|
Taxable income for last full year:
(from tax return) |
______________________________ | ______________________________ |
Please submit the original (which will be returned), or a photocopy of, your Notice of Assessment, as issued by Revenue Canada after filing your current tax return.
May we phone you for further information? yes/no Your Phone number: _______________
What amount do you feel you could pay toward lessons each month? $__________
Note: At present, due to limited funds and to ensure commitment, the minimum payment is $65.00/month.
Full cost per month is on average $420.00 for three hours/week or $280.00 for two hours/week.
Give your average monthly costs for the following:
| Rent or Mortgage (include taxes, insurance, if applicable) | $__________ |
| Hydro/heating/telephone | $__________ |
| TV/cable | $__________ |
| Travel Expenses (car insurance, gas, payments, etc.) and/or bus expense | $__________ |
| Food | $__________ |
| Medical.Dental expenses | $__________ |
| Clothing and school supplies | $__________ |
| Child care expenses | $__________ |
| Entertainment (sports/outings, etc.) | $__________ |
| Debt/Credit card and loan payments | $__________ |
|
Other expenses not listed above (orthodontic work, medications, etc.) |
$__________ |
| Total monthly income | $__________ |
| Total monthly expenses | $__________ |
| Difference | $__________ |
Is he/she willing to contribute to the cost of lessons at 4R's? yes/no How much? $__________
Are there family members (grandparents, etc.) who would help with costs? yes/no How much? $__________
Note: All those agreeing to contribute to the cost of lessons must sign a commitment agreement.
I/We the undersigned understand the information on this application will be kept confidential and used only for determining need for tuition subsidy.
Signed: ___________________________ Date: ____________
Signed: ___________________________ Date: ____________
N.B. All parents/guardians are asked to become members of the Society for $10/year. This fee entitles you to borrow books and tapes. We expect all parents to become involved with fund-raising and promotional events.