St. John’s Ev. Lutheran School

42685 County Road 12 – Nodine, Dakota, MN 55925  - 507-643-6440     stjohnsnodine.org

 
Tuition Grant 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
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)  _______________________________________________