FINANCIAL AID FORM Name * First Name Last Name Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Email * Employer Name/Company * Number of Family Members in the Home * DEBTS Mortgage/Rent * $ Minimum Credit Card Payments * $ Car Loan(s) * $ Student Loans * $ Alimony/Child Support * $ Other Loan/Debts * $ Incomes Income from Wages * $ Alimony/ Child Support * $ Bonuses or Overtime * $ Other Income * $ What amount can you afford towards your tuition? * Additional Comments: Disclaimer: I understand that the information I provide will be used only to determine amount of financial assistance and will be kept confidential. I understand that the information provided concerning my family income and family size is subject to verification by XploreNations Bible College. I understand that if any information I have given is determined to be false, it may result in reversing the financial assistance approval and I will be liable for the full amount of tuition. I certify that the above information is true and accurate to the best of my knowledge. Signature * First Name Last Name Thank you!
