4R's EDUCATION CENTRE (Soc.) 
581 McPhee Avenue
Courtenay, B.C. V9N 2Z7
Phone: 250-338-4890
Fax: 250-338-5639

FEE ASSISTANCE INFORMATION

Fee Assistance money is raised by the ongoing efforts of 4R’s staff, Board members, parents and volunteers. Currently, due to limited funds, there is an upper ceiling of $3,000.00 per student available. We require parents/guardians to assist in these fund raising efforts by volunteering 20 hours per school year per registered student. A cheque for $200.00 per student (post-dated to the end of the school year) is required as a deposit - upon commencement of lessons - towards these hours. Should allocated volunteer hours not be completed, cheques will be cashed at the end of June.

If you have any questions regarding eligibility, please contact the office at (250) 338-4890.

Tear off and return agreement below.

COMMITMENT AGREEMENT

An initial three to five month commitment - depending on the number of lessons per week (36 - 42 hours) - is required. Classes will continue for the agreed time as long as:-

∙	the student shows good attitude and effort
∙	the student shows reasonable progress
∙	the student attends classes regularly
∙	the parent or guardian makes payments for tuition on time

	I understand the above conditions and that I have been approved for Fee Assistance for (child’s name)
                                                    , for an initial three to five months (36 - 42 hours), leaving me to pay 
$                      per month. This I agree to do. I also agree to inform my child of the importance of good attitude, effort, progress and regular attendance and make every effort to support him/her in this.

Signed	                                                                        		Date	____________________________                                           

Print Name ________________________________	                                                                        

Fee Assistance Application - page two

APPLICATION for FEE ASSISTANCE

           	The 4R's Education Centre (Soc.), a non-profit organization, offers limited Fee Assistance to those who are unable to manage the full cost of individualized teaching. The amount available in the Fund varies and is allocated on a ‘need’ basis, according to demand and family circumstances. The Fund depends entirely upon donations and on various fund-raising events during the year. All parents are required to become members of the Society and asked to give assistance at fund-raising events but if you receive assistance you, or a person you designate in your stead, will be required to help out with these events. Your co-operation is requested when you receive a call for help.

The Fee Assistance Committee reviews all recipients every three to four months to ascertain need for assistance in order that a student may come/continue coming for help.

Please be aware that we cannot supply full fees for any student due to our limited resources. The amount available per month may vary according to the amount available for disbursement.

Please answer the following questions to the best of your ability.

Name by which the child is known __________________________________________________________                                                                                                           
  	
Father/Guardian                        			Mother/Guardian

Mailing Address:                                                      	Mailing Address:  ____________________________                                                      

                                                                            	___________________________________________                                                                                
     
Postcode:                                                                  	Postcode: ___________________________________                                                                 

Phone:                                                                      	Phone: ______________________________________                                                                      

Employer:                                                                 	Employer: ___________________________________                                                                 
	
Employer’s phone:                                                   	Employer’s phone: ____________________________                                                     
 
Full/Part time?                                                          	Full/Part time? _______________________________                                                           

If part-time - average hours per week                       	If part-time - average hours per week_____________                        

What was your taxable income (from tax return) for the last full year? ______________________________                                                  
Please submit the original (which will be returned), or a photocopy of, your Notice of Assessment, as issued by Revenue Canada after filing your current tax return.	

Fee Assistance Application - page three

What amount per month do you feel you could afford towards the cost of individual lessons?    ___       		Note: At present, due to limited funds the minimum required payment per month is $65.00 to ensure
	Note: At present, due to limited funds the minimum required payment per month is $65.00 
to ensure commitment. 

	Give your average monthly costs for the following:-
	
Rent or mortgage - please circle one (include taxes, insurance, if applicable)	$	
Hydro/heating	$	
TV/internet/telephone	$	
Travel expenses (car insurance, gas, payments, etc.) and/or bus expense	$	
Food	$	
Medical/dental expenses	$	
Clothing and school supplies	$	
Child care expenses	$	
Entertainment (sports/outings, etc.)	$	
Debt/Credit card and loan payments	$	
Other expenses not listed above (orthodontic work, medications or other financial commitments)	$	
Total monthly income	$	
Total monthly expenses	$	
Difference	$	
				
If you are a single parent, or have joint guardianship of your child(ren), do you receive assistance from your ‘ex’-spouse?  		Yes / No

Is he/she willing to contribute to the cost of lessons at 4R’s? 	Yes/No		How much? $___________                     

Are there family members (grandparents, etc.) who would help with costs?	Yes/No	How much? $______               

Names and ages of all other dependants:  ______________________________________________________

________________________________________________________________________________________                                                                                                            

May we phone you for further information?                                                                                             	
 
   	This information will be kept confidential and only reviewed by the Fee Assistance Committee.

	
	I/We, the undersigned, understand that the information contained on this application is to be kept
		confidential and used only for purposes of determining need for help in tuition costs.

     	Signed:_____________________________________________Date:________________________  

	Signed:_____________________________________________Date:________________________

      	N.B.  All parents/guardians are asked to become members of the Society for an annual fee of $20. This fee
		entitles you to borrow books and tapes.  We expect all parents to become involved with fund-raising
		and promotional activities. 									Revised  September 2018