Intent to Return Contract
Western Mennonite School
2013-2014 Parent/Guardian: (Printed Name)
Student: ______________________ Grade: ______
Student: ______________________ Grade: _____
Student: ______________________ Grade: ______
Student: ______________________ Grade: _____
Please check the following items for which you would like more information. _____ Dormitory application / scholarship
_____ Mennonite Church discount
_____ Family specific tuition & fees estimate
_____ Busing routes and fees
In consideration for the services provided by Western Mennonite School on behalf of my child, I agree to pay the tuition and fees in accordance with the method initialed below. Enclosed is my non-refundable registration fee for each student ($50 if returned by March 22, or $100 if returned after). _____ I will pay my child’s tuition in advance for one or both semesters. First semester payment due by July 1, second semester payment due by January 2 (2% discount on advance tuition paid by cash or check). _____ I will pay my child’s tuition in advance for one or both semesters through WMS PayPal. First semester payment due by July 1, second semester payment due by January 2 (no discount on tuition paid by credit card). _____ I agree to monthly automatic withdrawals for my child’s tuition and other expenses as they are incurred over _____ten months, beginning September 10 -or- _____ twelve months, beginning July 10. _____ I plan to apply for financial assistance and, based on acceptance of the award agree to monthly automatic withdrawals. Unless prior communication and arrangements have been made, I understand that late payments will be assessed a $20 fee and returned checks will be charged a $30 NSF fee. I understand that to be enrolled, my child must abide by the WMS Community Standards as found in the Student Handbook. If my child withdraws before the school year begins or during the year, I will notify the school in writing and it shall be effective when such notice is delivered to the office. If I submit notice of withdrawal after the first day of classes, I will be charged a prorated daily amount per school day enrolled. By signing below, I agree to the above terms and authorize payment via automatic withdrawal, which I am submitting or already have on file. I have enclosed the appropriate registration fee
_________________________________ Signature of Parent
______________ Date
___________________________________ WMS Director of Operations
Western Mennonite School 9045 Wallace Rd NW Salem, OR 97304
Automatic Withdrawal Authorization I/We hereby authorize Western Mennonite School to charge my/our account and financial institution for the purposes designed 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 notify Western Mennonite School, in writing, of any change in the account information provided in this authorization. Authorization will remain in effect until notification to terminate or limit is given in writing or by email. Personal Information Last Name: Phone Number:
First Name:
Middle Initial:
Email:
Mailing Address: City
State
Zip Code
Bank Bank Information Information (Attach (Attach aa voided voided check check -OR-OR- fill fill in in information information below) below) Name: Name:
Account Account Type: Type:
Checking Checking Savings Savings
Mailing Mailing Address: Address: City City Account Account Number: Number:
Routing Routing Number: Number:
State State
Zip Zip Code Code Amount: Amount: $_________ $_________
Authorized Signatures X Signature of Bank Account Holder
Date:
X Signature of Bank Account Holder
Date:
Mail To: Western Mennonite School | 9045 Wallace Rd NW | Salem, OR 97304
Western Mennonite School 2013-2014 Estimated Tuition & Fees (Keep for your records)
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 $7,110 100 110
Tuition Registration fee(s) Instructional materials fee
High School $8,600 100 215
SUBTOTAL Participation Fees Bus transportation First student
(2-way) (1-way) Second student (2-way) (1-way) Third student Transportation per trip
Meals Dorm 5-day room and board Weekend dorm fee Sports (per sport) Music Spring Choir Tour MSC Music Festival (estimate) Drama Fall Spring Yearbook Class dues Mini-Terms (meals included) SUBTOTAL Discounts Sibling (Discount applies to the second child) Matching Church Scholarship where available Need-based Grant * SUBTOTAL TOTAL COST 10 MONTHLY PAYMENTS (Starting Sept. 5)
Family Total
$
$690 415 400 240 Free 3.00 3.75
$690 415 400 240 Free 3.00 3.75
$125
5,179 2,198 $175 150 210
75 100 15
75 100 25 20-50 Starting at 60 $
($1000) ( ) ( )
($1000) ( ) ( ) $ (
)
* For information regarding our grant program please visit the school’s website at .WesternMennoniteSchool. or contact Rich Martin, Admissions Coordinator, at 503-363-2000. For priority consideration, please make sure Western receives your report from FAST by April 15.