2020 Fee Deferral Application Form

First Child's Full Name *

Current Year Group *

2nd Child's Full Name

3rd Child's Name

Current Year Group

Parent/Carer 1 Full Name *

Employer *

Occupation *

Parent/Carer 2 Full Name

Employer

Occupation

Nature of Circumstance
In order for the College to make an assessment of the fee deferral application, please provide details of your current financial circumstances. *

FAMILY FINANCIAL INFORMATION Please provide the family’s combined income (before taxation) for the past twelve (12) months and a forecast of your combined income in the next twelve (12) months.

Total Combined Family Income Past 12 Months *

Total Combined Family Income - Forecast Next 12 Months *

Any Other Financial Resources - Past 12 Months *

Any other Financial Resources - Forecast Next 12 Months *

GOVERNMENT’S STIMULUS PACKAGE
The Government has recently announced a stimulus package, such as cash for small and medium sized business ($20,000-$100,000), access to superannuation etc. Please indicate if you have applied for or will be eligible for any of the government support. *

No I am not Eligible

Yes I am Eligible

Type of government support and estimated amount:

DECLARATION

I/we swear/affirm that

I/we am/are the parents/carers of the child(ren) in this application

I/we am/are aware that I/we have an obligation to make a full and frank disclosure to Our Lady of Mercy College of my/our financial situation.

The information set out in this statement which is within my/our personal knowledge is true. Where I/we have given an estimate in this statement, it is based on my/our knowledge and is/are given in good faith. All other information given in this statement is true to the best of my/our knowledge, information and belief.

I/we have no income or financial resources other than as set out in this statement.

Parent/Carer 1 Signature *

clear

Parent/Carer 2 Signature

clear

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