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The Melissa Steinke Scholarship Application

- The Melissa Steinke Scholarship Program has been established to provide financial aid to those in need attending St. Joan of Arc (SJA) Catholic School. Scholarship requests for the upcoming school year will be accepted up to April 1.
  
  Every SJA family is required to pay $1,300 per year (equal to current tithing for parish members) to subsidize the cost of education, plus a voluntary per-child family contribution that will be used to help pay the mortgage for the new, state-of-the-art SJA school. Please see the details below. (These funds are separate from the State of Iowa ESA funds). We ask that every family participate financially according to their means.
  
  All information provided on this application will be kept strictly confidential, and reviewed only by the pastors of Our Lady of Lourdes (OLOL) and St. John Vianney (SJV), the OLOL business office, and a scholarship sub-committee.
- Requirements
  
  To receive scholarship funding, families must:
  
  1. Have a conversation with Fr. Jason or Father Rich if you are not up to date with the yearly required education subsidy payment (parish tithing agreement).
  
  2. Actively participate in the church and/or school community;
  
  3. Be up to date on past due tuition and/or school fees;
  
  4. Have signed and returned the SJA School Family Financial Responsibility Acknowledgement.
  Scholarships will be awarded based on financial need each year, and may take up to 6 weeks to process. This is an annual application process. Filling out the details below does not guarantee scholarship dollars will be awarded.

application

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Parent's Names (First and Last) REQUIRED Please fill out this field. Please enter valid data.
Address REQUIRED Please fill out this field. Please enter valid data.
City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.
Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
Secondary Phone Number Maximum 20 characters Please enter a phone number.
Email REQUIRED Please fill out this field. Please enter an email address.
Secondary Email Please enter an email address.
Which local parish do you support? REQUIRED Please fill out this field.
If Other, what parish? Please enter valid data.
Are you or your spouse/significant other employed by Scott County Catholic Schools? REQUIRED Please fill out this field.
If so, who is employed and to which Scott County Catholic School? Please enter valid data.
Total Annual Household Gross Income (The committee may request supporting documentation. Please see IA 1040 tax form, line 15): REQUIRED Please fill out this field. Please enter valid data.
Do you rent or own your home?
What is your monthly mortgage or rent payment? REQUIRED Please fill out this field. Please enter valid data.
Extraordinary Expenses
- Outgoing alimony monthly Please enter valid data.
- Outgoing child support Please enter valid data.
- Is an income earning member of your family currently unemployed?
- If so, who? Please enter valid data.
- Do you currently pay out of pocket medical expenses?
- How many students needing assistance? Please fill out this field.
- Student 1
  - First Name REQUIRED Please fill out this field. Please enter valid data.
    
    Last Name REQUIRED Please fill out this field. Please enter valid data.
  - Grade Level
- Student 2
  - First Name REQUIRED Please fill out this field. Please enter valid data.
    
    Last Name REQUIRED Please fill out this field. Please enter valid data.
  - Grade Level
- Student 3
  - First Name REQUIRED Please fill out this field. Please enter valid data.
    
    Last Name REQUIRED Please fill out this field. Please enter valid data.
  - Grade Level
- Student 4
  - First Name REQUIRED Please fill out this field. Please enter valid data.
    
    Last Name REQUIRED Please fill out this field. Please enter valid data.
  - Grade Level
- Student 5
  - First Name REQUIRED Please fill out this field. Please enter valid data.
    
    Last Name REQUIRED Please fill out this field. Please enter valid data.
  - Grade Level
- Student 6
  - First Name REQUIRED Please fill out this field. Please enter valid data.
    
    Last Name REQUIRED Please fill out this field. Please enter valid data.
  - Grade Level
- Student 7
  - First Name REQUIRED Please fill out this field. Please enter valid data.
    
    Last Name REQUIRED Please fill out this field. Please enter valid data.
  - Grade Level
- Student 8
  - First Name REQUIRED Please fill out this field. Please enter valid data.
    
    Last Name REQUIRED Please fill out this field. Please enter valid data.
  - Grade Level
- Student 9
  - First Name REQUIRED Please fill out this field. Please enter valid data.
    
    Last Name REQUIRED Please fill out this field. Please enter valid data.
  - Grade Level
- Student 10
  - First Name REQUIRED Please fill out this field. Please enter valid data.
    
    Last Name REQUIRED Please fill out this field. Please enter valid data.
  - Grade Level

Yearly Required Education Subsidy Payment	$ 1,300
*Plus Yearly Voluntary Per-Child Family Contribution (See table below)	+ $
Total Yearly Family Financial Commitment	= $
**Less What Your Family Can Pay (due August 1, see note below for payment info.)	- $
Less Current Education Subsidy (Tithing) Payment (enter only up to $1,300)	- $
Scholarship Dollars Being Requested	= $

Scholarship Dollars Being Requested REQUIRED Please fill out this field. Please enter an integer (number).
How do you currently participate in parish and church life? REQUIRED Please fill out this field.
Do you volunteer time at Lourdes Catholic School and/or St. John Vianney Preschool, and how do you spend this volunteer time? REQUIRED Please fill out this field.
In the future, how would you like to use your time and talent to benefit the parish, church, and community? REQUIRED Please fill out this field.
What additional organizations do you belong to and what do you do to benefit these organizations? REQUIRED Please fill out this field.
What is/are your expectation(s) of St. Joan of Arc Catholic School? REQUIRED Please fill out this field.
Have you had a conversation with Fr. Jason or Fr. Rich if you are not up to date with tithing agreement(s)?
Are you up to date with all parish and school fees, and if not, please explain. REQUIRED Please fill out this field.
Have you signed and returned the SJA School Family Responsibility Acknowledgement? REQUIRED Please fill out this field.
If not, see here.
Digital Signature: You certify that all the information provided on this application is accurate.
I Agree Please select this field.

Submit

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