Unity Lutheran Christian Elementary School

A Mission Outreach of the Southern Illinois District – LCMS

TUITION COVENANT and REQUEST FOR FINANCIAL AID 2026 -2027

“Know therefore that the Lord your God is God; He is the faithful God, keeping his covenant of love to a thousand
generations of those who love Him and keep His commandments.” Deuteronomy 7:9

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This field is for validation purposes and should be left unchanged.

Parent/ Guardian’s Name(Required)

First Middle Last

Parent/ Guardian’s Name

First Middle Last

Address(Required)

Street Address City State / Province / Region ZIP / Postal Code

Phone: Home(Required)

Phone: Work

Phone: Other

Number of people in household(Required)

Adults

Children

Please list all children in the household who will be entering grades PK – 8th at Unity Lutheran Christian Elementary School:(Required)

Name

Gender

Relationship to guardian

Grade level in 2025- 2026

Monthly Income

Salary

Father

Mother

Other

AFDC or ADC

Father

Mother

Other

Other Public Assistance

Father

Mother

Other

Other Income

Father

Mother

Other

Total

Father

Mother

Other

All information shared is confidential and used solely for school-related financial considerations.
To verify income, please attach a copy of your most recent federal tax return and/or two most recent pay stubs. Do not include schedules, attachments, or worksheets. Only include the 1040 or 1040EZ form. If you would like a free copy of your federal tax return, please call the Internal Revenue Service at (800) 829-1040.

Please describe any special family or financial circumstances that you would like to be taken into consideration or would like the school to be aware of: (Attach an additional sheet if necessary.)

Tuition amount you can pay per month

Please initial each statement to indicate the statement is true:

I understand that no child will be enrolled without a zero balance.

I certify the above financial information is correct.

I understand that there are ten monthly tuition payments, August through May.

I understand that tuition payments are due on the 15th of each month (including August).

I understand that my child will not be allowed to attend class if tuition is not paid on time.

I understand that student records and/or diplomas will not be issued if charges remain.

I understand that it is the parent/guardian’s responsibility to monitor the tuition balance. Unity provides a statement at least monthly

I certify that all information provided on this application is true and complete to the best of my knowledge. I agree to provide documentation to verify any statements made in this application, if requested. I understand that failure to do so may result in the forfeiture of scholarship eligibility. I acknowledge that the student and family must meet all stated conditions to remain eligible for a scholarship.

Print Name of Parent or Guardian

Signature of Parent or Guardian

Date

Print Name of Parent or Guardian

Signature of Parent or Guardian

Date

FULL TUITION

$620/month per child x

Total

Financial Aid Per month

Parent Monthly Tuition