Automatic Bank Withdrawal Authorization | 2014‐2015
I/We hereby authorize Western Mennonite School to charge my/our bank account for the purposes designated below. My/Our bank is authorized to handle withdrawals on the 10th of each month or the next banking day as if I/we had personally issued a check. I am/We are all the persons whose signatures are required to sign on the account below. I/We will undertake to promptly no fy Western Mennonite School, in wri ng, of any change in the account informa on provided in this authoriza on. Authoriza on will remain in effect un l no fica on to terminate or limit is given in wri ng or by email. Personal Informa on Last Name:
First Name:
Phone Number:
Middle Ini al:
Email:
Mailing Address:
City
State
Zip Code
Bank Informa on (A ach a voided check ‐OR‐ fill in informa on below) Name:
Mailing Address:
Account Type: Checking Savings
City
Account Number:
State
Rou ng Number:
Zip Code
Amount: $
Authorized Signatures X Signature of Bank Account Holder
Date:
X Signature of Bank Account Holder
Date:
______
Western Mennonite School
_____
Financial Planning Informa on | 2014‐2015
This worksheet is provided to help estimate the annual or monthly cost of education. Please contact the school business office with any questions regarding payment schedules or special arrangements. We appreciate the investment you are making and are committed to serving you and your children. Middle School
High School
$7,110
$8,600
Registration fee
100
100
Instructional materials fee
110
215
Tuition
SUBTOTAL
Family Total
$
Participation Fees Bus transportation First student
(2-way)
$690
$690
(1-way)
415
415
Second student (2-way)
400
400
(1-way)
240
240
Third student
Free
Free
Transportation per trip
3.00
3.00
3.75
3.75
Meals Dorm 5-day room and board
5,179
7-day room and board
7,377 $125
Sports (per sport)
$175
Music Spring Choir Tour
150
MSC Music Festival (estimate)
210
Drama Fall
75
75
Spring
100
100
15
25
Yearbook
20-50
Class dues
Starting at 60
Mini-Terms (meals included) SUBTOTAL
$
Discounts Sibling (Discount applies to the 2nd child)
($1000)
($1000)
Matching Church Scholarship if available
(
)
(
)
(
)
(
)
Need-based Grant * SUBTOTAL
$
(
)
TOTAL COST 10 MONTHLY PAYMENTS (Sept. 5) * For informa on regarding our grant program please visit the school’s website at www.WesternMennoniteSchool.org or contact Rich Mar n, Admissions Coordinator, at 503‐363‐2000. For priority considera on, please make sure Western receives your report from FAST by April 15.
One Form Required Per Family
Grandparent Information | 2014‐2015 Student Name (s):
Western Mennonite School values the role that many grandparents play in the lives of our students. Every year Western hosts a Grandparent Day in which all grandparents are invited to the campus to enjoy lunch with their grandchild. This event has received great feedback from both students and grandparents. Please provide the following information: Name(s)
Address
Name(s)
Address
Name(s)
Address
Name(s)
Address
Phone
Phone ___________________
Phone ___________________
One Form Required Per Family
Phone ___________________
Media Consent MEDIA CONSENT AND RELEASE: Students at WMS are occasionally asked to be a part of school publicity, publica ons, and public rela ons materials and programs (including but not limited to print, web and video). In order to guarantee student privacy, Western Mennonite School requires parent/guardian authoriza on permi ng its use of student infor‐ ma on. By signing below, I give Western Mennonite School permission to use informa on about my student in school publici‐ ty, publica ons, and videos or on the school’s website. Informa on includes, but is not limited to, student’s name, pic‐ ture, art projects, wri en work, voice, verbal statements or portraits (video or s ll). I understand that this informa on may be used in subsequent years. Parent/Guardian Signature ________________________________________________ Hometown Newspaper ___________________________________________________ If you do not want WMS to use student informa on in specific areas, please indicate what you do not authorize below:
NOTICE REGARDING DIRECTORY INFORMATION: I hereby give consent for the student’s grade level and parent’s address and phone number to be listed in the school directory. ☐ YES ☐ NO If NO, please send a wriƩen request to the school.
Church Attendance We currently a end a church ☐ YES ☐ NO Denomina on __________________________________________ Name of Church _____________________________________________ City _________________________________ Pastor __________________________________ Youth Pastor _____________________________________________
Parent Volunteers If you are interested in volunteering at Western please fill out the following information and you will be contacted accordingly. Parent/Guardian Name: Home Phone:
Cell Phone:
E‐Mail:
___ Bulletin Boards
___ Field Trip Chaperone
___ Benefit Auction (May)
___ Parents in Prayer
___ Drama Support
___ Photography
___ Golf Tournament (Sept.)
___ Student Grant Phonathon Caller
___ Grounds/Facility Maintenance
___ Office Support
___ Hospitality Home (Host international students for extended weekends/year. ____ Male ____ Female) Find more opportunities online at www.WesternMennoniteSchool.org/volunteers