Date

Dear Inquiring Parent:

Enclosed is a concessionary fee application form for the 19   /19    school year. According to school policy you are required to submit the following documents before April 15,  to the Y.I.S Treasurer, Mr. Andy Ulrich, in order for the School Board to consider your concessionary fee application:

Please be advised that all the above documents are required by April 15 for the School Board to consider your application. Thank you.

Regards,
 

Andy Ulrich
YIS Treasurer

APPLICATION FOR SPECIAL REDUCTION OF TUITION FEES (FOR 19    /19    )
FATHER & MOTHER
Name  Employer 
Home Address
Work Address 
Home Telephone 
Work Telephone 		 STUDENT NAME
Name 
Birth date 
Citizenship 
New Student Yes / No
OTHER CHILDREN IN YOUR FAMILY
Name 
Birth date 
Citizenship 
New Student Yes / No		 FATHER’S INCOME
 In Indonesia 
Outside of Indonesia
Annual Salary 
Taxes Paid 
Net take home salary 
MOTHER’S INCOME
 In Indonesia 
Outside of Indonesia
Annual Salary 
Taxes Paid 
Net take home salary 		 ADDITIONAL INCOME
 In Indonesia 
Outside of Indonesia
Source 
Amount 
 
SCHOOL FEE SUBSIDY FOR ABOVE STUDENT(S) RECEIVED FROM  EMPLOYER OR OTHER (AMOUNT PER ANNUM):
 
 
 
 
 

 

 EXPENSES
Annual Amount Paid by Employer
Home Leave 
Education 
Housing 
Household Staff 
Utilities

Medical 
Dental 
Transportation

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