Online Flexible Tuition Form

CCJDS Flexible Tuition/Financial

CCJDS Flexible Tuition/Financial Aid Form

If you prefer to complete a paper version of this form, you can download and print it here and then submit it by mail or deliver it personally to CCJDS Admissions, 955 Risa Road, Lafayette, CA 94549.
Please complete this form ONLY if applying for flexible tuition/financial assistance.
  • Parent/Guardian #1 First Last
  • Home Phone: - -
  • Cell Phone:
    - -
  • Email
  • Parent/Guardian #2 First Last
  • Home Phone: - -
  • Cell Phone:
    - -
  • Email
  • List All Children: Name/Age/Gender

Please provide the summary pages of your most recent tax return and answer the following questions fully to provide an accurate and complete picture of your present financial position. The fairness and success of our financial assistance depends on your full and candid response to the following questions.

  • Salary: Parent/Guardian #1
  • Salary: Parent/Guardian #2
  • Interest & dividend income
  • Profit & loss from business
  • Other income
  • Total monthly rent and/or mortgage (less real estate taxes) *
  • Real Estate taxes paid in 2019
  • State income taxes paid in 2019
  • Federal income taxes paid in 2019
  • Total other large expenses (please specify below)
  • Please specify other large expenses:
  • Will your tuition be paid from any other source?
    (if yes, please specify)

  • Approximate value of real estate owned and date purchased
  • Approximate amount of loans against real estate
  • Total deposited in savings and checking accounts
  • Total value of stock & bond portfolios and other asset accounts
  • Total Household debt (please itemize)
  • Please provide any other information that would help you evaluate your applications for tuition assistance in the box below. Also, please let us know if you anticipate any significant changes in your financial position in the upcoming year.
  • Please submit your most recent Federal Income Tax Return to the CCJDS Business Office to be reviewed with your application. Please note, in the box below, when the return will be sent.
  • Electronic Signature *
    I accept

    Please check the box in lieu of a written signature.

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