$100 per student non-refundable registration fee (+$50 surcharge for returning students = $150 after May 1, 2017)

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1 Welcome to St. Jude: Student Registration Checklist Thank you so much for taking this final step to register your child(ren) for the academic year. This is a listing of the documents required to complete your registration. Please be advised that other forms in addition to this packet may be required before school begins. $100 per student non-refundable registration fee (+$50 surcharge for returning students = $150 after May 1, 2017) Family Registration Form (required-one per family) Student Registration Form (required-one per child) Emergency Information Form/Medical Authorization (required-one per child) Tuition Status Request Form (required-one per family) Active Registered Contributing Parishioner Verification (required-one per family) Tuition Payment Form (required-one per family) (and register for payment plan): Birth certificate (required for NEW) / Baptismal certificate (required if Catholic) Medical documentation (required for NEW in hard copy in the school office) Legal guardian/custody documentation (required if NEW or status change) NOTE: By diocesan policy, placement testing is required for all new students, including Kindergarten. Acceptance of this application by the school is contingent on agreement to appropriate placement as determined through a review of educational records, placement testing, and applicant interviews. Family handbook notification All families attending St. Jude must read and agree to the terms of the Family Handbook, and sign off on their agreement. The revised handbook usually becomes available near the beginning of August. Nonetheless, we encourage families to learn about our policies now. The handbook also contains valuable information about all of our programs such as pick-up and drop-off procedures, use of medication, dress code, grading policies, hot lunch program, and aftercare. (or ask the office for a copy)

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3 Active Parishioner status (K-8) General information You will be allowed to apply for tuition at the active parishioner rate, which includes any subsidies provided by the parish if by June 30 of the year of application our records show that you are a Registered, Active, and Supportive member of St. Jude Parish. By Active, we mean that you regularly attend Mass and practice your faith; contribute of your time and talent in school and/or parish. By Supportive, we mean that you exercise responsible stewardship in support of your parish; that is you are contributing members, sharing your time, your talents and your treasures through the regular use of your Sunday collection envelopes. Specifically, families will be evaluated by the Finance Council on the following three areas: 1. ATTENDANCE AT ST. JUDE CHURCH (and/or Sacred Heart of Jesus), as documented first and foremost through the regular return of offertory envelopes provided by St. Jude Parish. The fact of an envelope being returned (the manner or amount of giving notwithstanding) will be accepted as evidence of regular attendance. 2. SERVICE HOURS performed to the benefit of St. Jude School, St. Jude Church, or Sacred Heart of Jesus Church, as documented and reported to the school. The expected amount will be 30 hours per family per year, July 1-June 30 of the same school year. 3. REGULAR or SUBSTANTIAL CONTRIBUTIONS TO THE PARISH OFFERTORY, as received through envelopes or electronic means. Each family should contribute according to their means on a consistent basis.

4 Service hour agreement The St. Jude School service commitment program, applicable for families with students in Grades PreK-8, was created to help meet the needs of the school through total involvement of the parents. High parental involvement is one of the reasons for the success we are able to provide in the classroom as well as the many supporting activities, programs, facilities, and perks that our students, parents, and staff members receive. All school families are expected to contribute at least 30 hours per school year. The reporting period runs from July 1 through June 30. For families of an 8 th grade student, required hours must be met prior to graduation. The timely completion of service hours will be used as one factor in reviewing each family s annual eligibility for in-parish tuition rates and financial aid. Hours may be worked on behalf of any school or church function (including for Sacred Heart of Jesus Church), including meetings and committees. Time given in ministry during worship is NOT counted, since that is part of every family s obligation. It is the parents responsibility to seek out ways to serve their hours as opportunities are announced throughout the year. SCRIP participation program The SCRIP program, applicable to all families, including Pre-K through 8 th, helps St. Jude and our families by raising money that supports technology and helps pay for your tuition. We receive a percentage of proceeds back from the sale of gift cards and certificates to local and national retailers. Our SCRIP participation program encourages all families to get involved in the benefits of the SCRIP program. Each family is asked to purchase SCRIP worth a total amount of $1000 in value between the calendar dates of June 1 and May 31 of the coming school year. For example, when spread out over the 10 months from August to May, a family could meet the quota by spending as little as $100 per month using the gift certificates and cards available through the SCRIP program. One could spend $100 in gas and groceries in one day alone! Families who meet their quota will receive 40% of their total profit from the SCRIP program to as credit toward payment of their tuition for the following school year. We hope that families will find this to be an achievable goal. A consistent and planned use of SCRIP benefits all.

5 Scholarships & Financial Assistance at St. Jude (K-8) St. Jude wants a Catholic education to be available and affordable to every family. We do everything we can to provide need-based aid to parish families who have a genuine financial need. There are currently 4 ways to receive assistance with your tuition. All assistance approved is good for one school year only and must be reapplied with each new school year. 1. Indiana School Choice Scholarship To qualify a child must find a qualifying pathway: 2 prior semesters in a public school, continuing voucher, previous voucher, prior SGO, sibling voucher/sgo, special needs (IEP), or reside in a failing school district. A student seeking a School Choice scholarship (voucher) must also meet income qualifications (see chart on the back side). There is a 50% level and a 90% voucher, with the specific award amount determined by the public district in which you reside. Our annual lottery date for voucher placement is May 1, after which a waiting list may be established. Additional information available: APPLY by appointment with the principal. DEADLINE IS SEPTEMBER Scholarship Granting Organization Scholarship (SGO) Any students entering Kindergarten through 8 th Grade are eligible to receive an SGO with a qualifying income (see chart on the back side). This scholarship begins at $500 and may be increased depending on need. Any recipient or their sibling becomes legally eligible to receive a voucher in future years if income requirements are met. To apply, use the FACTS Grant & Aid online application ( and select St. Jude (South Bend) as your school PLEASE SUBMIT BY MAY Large Family Fund Any family who has 3 or more children enrolled in ANY diocesan (Catholic) grade schools or high schools may receive assistance from the Large Family Fund if their income qualifies. To apply, use the FACTS Grant & Aid online application ( and select St. Jude (South Bend) as your school. DEADLINE IS SEPTEMBER Eugene & Mary Myers Scholarship Fund If a family does not qualify for any of the above scholarships, The Myers Fund may be able to provide assistance. In addition to the standard family size and income formula, the Myers scholarship may take exceptional situations into account. To apply, use the FACTS Grant & Aid online application ( and select St. Jude (South Bend) as your school. PLEASE SUBMIT BY MAY 1.

6 Voucher/SGO Income limits: Household size 100% Voucher 50% Voucher SGO/Special Ed/Continuing 2 $30,044 $45,066 $60,088 3 $37,777 $56,666 $74,554 4 $45,510 $68,265 $91,020 5 $53,243 $79,865 $106,486 6 $60,967 $91,464 $121,952 7 $68,709 $103,064 $137,418 8 $76,442 $114,663 $152,884 Each additional +$7,733 +$11,600 +$15,466 St. Jude Parish Financial Aid Rules (including Eugene & Mary Myers Fund) Families wishing to be considered for and receive financial aid from the St. Jude Parish fund must meet these conditions: 1. You must be a registered, active, and supportive member of the parish (or if a non-parish family, in good financial standing). In-parish families receive priority. 2. If you are not Catholic or not from St. Jude Parish, you must complete your 30 hours of school service to remain eligible for future financial aid consideration. 3. You must be paid up to date with this year's tuition. If you are on an extended payment plan, you will need to be paid in full by June 30 to receive final approval. Use the SCRIP program!!! ***Frequent use of the SCRIP program is an excellent way to offset your tuition costs for the next school year. Any family, regardless of whether they qualify for aid, may receive the benefits of using SCRIP, as described on the previous page.

7 K-8 Tuition and Fee Schedule (Published March 27, 2017) ACTIVE PARISHIONER TUITION REGULAR TUITION Tuition (per child) 1 st child 2 nd child 3 rd child Each add. 1 st child 2 nd child Each additional $5655 $11,310 $16,965 +$5655 $5655 $11,310 + $ Fees* $425 $850 $1275 +$425 $425 $850 + $425 St. Jude Parish Support** Family TOTAL -32% -$ % -$ % -$8766 -$3930 n/a n/a n/a $4130 $7280 $9474 +$2150 $6080 $12,160 + $6080 each Per student family rate 10 monthly FACTS payments daily cost per child (180 days) $4130 $3640 $3158 $403.00/ month $708.00/ month $917.40/ month $598.00/ month Cost of 10 monthly payments after credit for $100 per student advance registration fee. $22.39/day $19.67/day $16.99/day $33.22/day Post reg. cost / # children / 180 school days PRE-K TUITION 5-day full time 5-day AM / 3-day full time Registration fee: $3395 $2395 $100/student (after paid registration) (after paid registration) 3-day AM only $1995 (after paid registration) 2-day spring semester $1095 (after paid registration) *Returning students registered after May 1, 2017 will be charged an additional $50 late registration fee. ** The per pupil cost for is $6,080. Members of St. Jude Parish generously contribute an additional amount (beyond the family tuition) to pay the additional cost of each student s education.

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9 Diocese of Fort Wayne South Bend St. Jude Catholic School: FAMILY Enrollment [Please Print!] Office Use Only - Last Name: School Year Returning Family New Family Today s date: Religion: Registered Parishioners at: Home Address: Home Phone: City, State, Zip: Mother s or Guardian s Information First Name Last Name Living Deceased Education (check highest level reached): Grade School High School College Courses College Degree Postgraduate Cell Phone: Address: Occupation: Employer: Work Phone: Father s or Guardian s Information First Name Last Name Living Deceased Education (check highest level reached): Grade School High School College Courses College Degree Postgraduate Cell Phone: Address: Occupation: Employer: Work Phone: List children who will attend St. Jude: NAME BIRTH DATE (mon/day/year) AGE NAME List all other children in family: BIRTH DATE (mon/day/year) AGE Children live with: Both Parents Mother Father Stepmother Stepfather Other: Parents Marital Status: Married Single, never married Divorced* Separated* Remarried* (* copy of custody/guardianship papers required) Is there a language other than English often spoken in the home? If yes, what? Does at least one parent read English? If no, what language can you read? Signature of Parent/Guardian: Date:

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11 Diocese of Fort Wayne South Bend St. Jude School: STUDENT Enrollment (Each child attending St. Jude must have this form on file) [Please Print!] Office Use Only Last Name: Student ID: Baptism Certificate on file? Birth Certificate on file? Entering Grade in (school year). (Placement testing is required for ALL new students. An interview may be required for new students enrolling in grades 5 8) Student s Name: Sex First Middle Last Date of Birth (Mon/Day/Year) City, State & Country of Birth Address: (Street Address) Home Phone: Medical Condition (Allergy, Asthma, Heart Condition, etc. Please be specific): Student s Ethnicity / Race Data - Both Questions must be answered (for statistics only): Is this individual Hispanic / Latino? (Choose only one) No, not Hispanic / Latino Yes, Hispanic / Latino What is the individual s race? (Choose one or more) (City, State, Zip) American Indian or Alaskan Native Asian Black or African American Native Hawaiian or Other Pacific Islander White Student s Religion: Baptism: Communion: Confirmation: Date: Church: City: State: Date: Church: City: State: Date: Church: City: State: Did this child attend St. Jude last year? If no, where did this child attend school? School Name: City: State: In what public school corporation does the child reside? If your child resides in the South Bend Community School Corp., what is his/her local school? Has this child ever received any special services (for a behavioral disability, learning disability, physical or academic impairment, communication disorder, etc.)? Yes No If yes, what services were received? What was the first language learned by the student? Does the student often speak a language other than English? If yes, what? Signature of Parent/Guardian: Date: Final decision on enrollment of a student rests in the discretion of the principal (in consultation with the pastor in the case of an elementary school). (P4020). If applicable, admission is not determined until confirmation is received from prior Catholic school that financial obligations are current (4020).

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13 Diocese of Fort Wayne South Bend St. Jude Catholic School: Emergency Information The information below must be kept on file in the school office. Complete this form for each child and send it back to school tomorrow. Parents must complete this form prior to the start of the school year. PLEASE PRINT! Parents are responsible for informing the office during the school year if changes in emergency information occur. Name of Child Grade Name of Parent(s) or Legal Guardian(s) Address Home Phone City, State, Zip Who should we call if there is an emergency regarding this child, and in what order should we call them? (This list should include parents & guardians) Name Relationship to Child Phone Number(s) Please check CONSENT TO EMERGENCY CARE Cell phone Home Work Cell phone Home Work Cell phone Home Work Cell phone Home Work Cell phone Home Work In the event of an emergency, I request that the school make reasonable attempts to contact me at the above numbers or another parent/adult at the above listed numbers. I understand that in an emergency, difficult circumstances may prevent the school from contacting me immediately or the school may be unable to reach me. I therefore consent to the school s taking action which it deems necessary to secure emergency medical care/treatment for my child even if I have not been contacted. I understand that decisions concerning the type of emergency medical care/treatment administered are made by health care providers and not by the school and that demanding circumstances may require the administration of emergency medical care or treatment without my prior consent. However, I have indicated below any treatment preferences I have for my child which the school may disclose to a health provider. (Check and complete any of the following) Dr. is my preferred physician. (Phone: ) Dr. is my preferred dentist. (Phone: ) Preferred hospital: Memorial Hospital / St. Joseph Regional Medical Center Receipt of my consent prior to my child s receiving major surgery, unless the medical opinions of two licensed physicians or dentists concurring in the necessity for such surgery are obtained before surgery is performed. The school may disclose the following checked information to a health care provider: Insurance Company: Policy/Group/Claim # The following information regarding allergies my child has, medication my child is taking, and other medical facts about my child: I understand that in the event of an emergency, the school will make reasonable efforts to notify a health care provider of the abovechecked information; but I acknowledge that I am responsible for communicating such information to the appropriate medical personnel. Date: Signature of Parent/Guardian:

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17 Tuition Status Request Form (required) PLEASE (X) AND INDICATE YOUR PREFERENCE BELOW: I request that my child/children s tuition be assessed based on our status as an active parish family. We understand the new definition of active and supportive as communicated in this enrollment packet and understand that our service hour record is included as part of that obligation. *NOTE* The Diocese now REQURES families to complete the Active Registered Contributing Parishioner form, to be affirmed by the pastor, in order to receive parish tuition rates. This is included on the next page of this packet. Families may be charged standard tuition if this form is absent or the applying family does not qualify. I attend another Catholic parish that does not have its own grade school. I will complete the necessary steps to remain active at that church, ensuring that the parish will send the equivalent subsidy on behalf of my child/children. St. Jude will reduce the amount of tuition that we owe accordingly. Name of parish: Pastor: I shall enroll my child/children at the standard per-pupil rate. We understand that we are technically excused from any parish obligations, but we must still complete at least 30 service hours if we wish to remain eligible for any financial aid support Parent/guardian name(s): Child(ren): (List all, including last names if different than the parent listed above) Parent/guardian sign: Date:

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19 ACTIVE REGISTERED CONTRIBUTING PARISHIONER VERIFICATION Dear Parent, This form is required to establish your tuition rate as Active Parishioner at Catholic Church, Fort Wayne/South Bend Diocese. Please take this to your parish for the Pastor s signature. Return this to the school office so that your tuition level can be established. Please return as soon as possible. Your tuition rate will be considered Non-Parishioner/Non-Active until verification is received. Family Name Address Phone Number Children (attending Catholic Elementary School) Name Grade Name Grade Name Grade Name Grade Name Grade By signing below, the Pastor acknowledges the family meets the Parish criteria of an Active Registered Parishioner. Pastor Signature Parish Date Hildebrand Street South Bend, IN Ph Fax St. Jude Catholic School is committed to helping our students achieve their spiritual, academic, and social potential for success as lifelong learners.

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21 TUITION PAYMENT FORM PARENT/GUARDIAN S NAME: ADDRESS: CITY: STATE: ZIP : Phone: STUDENT NAME(S): ( X if applicable): My family would like to be considered for any available tuition assistance. I understand that I may apply for aid online at Please read carefully! Tuition for the school year will be paid by: Option 1 - I am new to St. Jude School, did not used FACTS last year, or I used FACTS but my banking information has changed. I understand that I must go online to register for the program at Option 2 - I used FACTS last year and my banking information has not changed. Please reenroll my family. I will still be asked to choose a one time payment at no cost to me or use the monthly payment plan at a cost of $46. For Option 2, please select one of the following payment schedules: A. one-time payment in full at no charge of $20 B. ten (10) monthly payments at a one-time charge of $46 FACTS offers an optional Peace of Mind Tuition Protection Program. For a nonrefundable annual fee of $17 per FACTS Agreement, FACTS will pay the remaining unpaid balance (except payments in arrears) on your FACTS Agreement(s)in the event of the death of the Responsible Party or his/her legal spouse. Please indicate your desire to make use of the Peace of Mind Tuition Protection Program. For more information on this program please contact Mary Krisch at the Parish Office. Yes, I want to sign up for the FACTS Peace of Mind Program. If yes, please provide: SSN: - - Date of birth / / Married Single No, I do not want the optional tuition protection program Your child may not be enrolled until we receive this completed form. If you have any questions, please contact the business office at I agree to make tuition payments for according to one of the options above. Parent's Signature Date

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23 Parental Legal Custodianship Form If you are a divorced/remarried/adoptive parent; a legal guardian; or you possess any legal documentation concerning your parental status that would differ from the child s birth certificate, we will require you to provide up to date copies of that information before your children arrives for the incoming school year. We must verify that you (the enrolling parent) have the legal decision-making authority concerning your child s education. (It is widely recognized that a noncustodial parent might not have legal custody, but does retain the right to access records unless expressly prohibited by court documents). This information is important to protect you should another person come to us on behalf of your child and claim that they wish to view records, withdraw your child from school, pick up after school, or make some medical decision on his or her behalf. By providing us with this documentation, you are assuring us of whom we should or should not allow to act for you and your child. Upon the receipt of the most recent documentation, we will destroy any previous records that we have on file. We appreciate your cooperation about such a sensitive topic. PLEASE CHECK ONE OPTION AND ATTACH ANY RELEVANT DOCUMENTATION I attest that my child/children have no outstanding custodianship concerns. We do not have any relevant paperwork to submit concerning our child/children s status. I understand that my child s enrollment will not be complete for the fall semester until I have verified that my custodial paperwork is on file for these children. Please inform me if the school does not have custodial paperwork for the children listed below. We will provide it upon request.,,, Parent sign: Date: School office use only Paperwork is on file and current; added to file or updated; not present Initial: Date: