Application for the MMCS Tuition Discount Program
Please Print Office Use Only: Date Received: ________________ Answer
the following questions to the best of your knowledge. All information will be kept
confidential. Your Name___________________Student Name:
________________Class: ________ Address
________________________________________________________ Street
________________________________________________________
City
Zip County Phone
_________________________________________________________ (Where you can be
reach during the day) Number of people in your family
_______________________________________
(Counting
you) (Please
circle) Household income $_______________________ week
2 weeks month year (Before taxes) Income Eligibility Table FAMILY
SIZE Weekly Biweekly Monthly Annual 316 631 1,366 16,391 425 850 1,841 22,089 THREE 535 1,069 2,316 27,787 FOUR 644 1,288 2,791 33,485 FIVE 754 1,508 3,266 39,183 SIX 864 1,727 3,741 44,881 ADDITIONAL 110 220 475 5,698 Please
check your household income eligibility and attach your last year tax
return or other income documents Office Use Only:
Discount rate:
________________ MMCS Officer: ________________ Date:
________________
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