Pink Arrow IV T-shirt
Financial Assistance Form
Through the generosity of several Lowell families who have made donations, Pink Arrow t-shirts are being made available to students that need financial assistance at a reduced cost. Youth sizes x-small to adult x-large are $4.
Personal Information
Name of parent/guardian of student to receive assistance__________________________
Address __________________________________________________________________
Phone______________________
Number of adults in the home_________ Number of dependents____________
Are you currently employed? Yes or No
Employer___________________________________
If you receive state, federal, or county aid, food stamps, medical aid, free or reduced lunch, etc., please circle.
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Total Amount Due $____________
The undersigned acknowledge that the information contained in this application is considered confidential and will be made available to employees and officers, agents, or others where it is reasonably necessary to review financial assistance funds. I certify that the information I have
Provided is accurate and correct to the best of my knowledge.
_______________________________________ ________________
Signature of applicant Date
Please return application and money or check made out to Lowell Area Schools no later than Thursday, September 8, to any Lowell School building principal.