Parent First and Last Name

Email

Student Name

Please provide all forms of monthly income

Please list regularly occurring Monthly Expenses (E.g. Rent $_____, Car Loan $_____)

What can you commit to pay monthly toward LEAD Academy tuition?

Would you be able to volunteer in some capacity at LEAD Academy? How?

Are you affiliated with a local Christian church? Are you affiliated with a local Christian church? Yes No

If so, please list the name of the church and city.

Please let us know any other information necessary for making a decision for financial assistance.