Parent/Guardian Name
*
First Name
Last Name
Parent/Guardian Phone Number
*
(###)
###
####
Parent's Email address
Employment
Are you currently Employed?
If yes, please provide the business name of the employer:
What is your take home pay per month?
Marital Status
If Married and not separated, is your spouse employed?
If yes, please provide the business name of the employer:
What is his/her take home pay per month?
Please provide the names, ages and relationships of all the people in your home for whom you provide support:
Monthly average spent on rent or mortgage:
Monthly average spent on Food:
Monthly average spent on utilities:
Monthly average spent on daycare:
Monthly average spent on child support:
Monthly average spent on clothing:
Monthly average spent on medical expenses:
Monthly average spent on vehicle payments (car, van, motorcycle, etc.):
Monthly average spent on transportation (gas):
Monthly average spent on Insurance (medical, property, vehicle, life):
Monthly average spent on credit card debt:
Student Name
*
First Name
Last Name
Student's Gender
*
Student's School
*
Grade Student is in
*
Student's T-shirt Size
*
Student's Jersey Size
*
