FINANCIAL ASSISTANCE PROGRAM

We are fortunately able to offer limited financial assistance to parents looking for services who are in financial hardship. We understand finding affordable resources is difficult. Not all applicants are guaranteed approval, but we encourage those who need it to apply. Funding is made possible by the incredible work being done and our partnership with the Literacy Foundation of Nebraska.

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FINANCIAL ASSISTANCE APPLICATION

Student Name

First Name

Last Name

Birthdate

Grade

Current school

Text

Does your student currently qualifiy for an IEP or 504 Plan?

Click all that apply

IEP

504 Plan

Other

Does your student currently deal with dyslexia or any other learning difficulty?

Are there any significant heealth or behavior concerns?

Parent/ Legal Guardian Information

Parent Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Financial Information

Estimated Gorss Annual Income

Please tell us what your (pre-tax) earnings where last tax year. (find this number on your latest tax return)

Please describe in detail why you feel your child would benefit from attending Simplistic Learning Academy