Application

Financial Application

Please mail us or fax us this application

Parent/Guardian			SSN					Date of Birth
Address			Zip				How Long	Telephone
Former Address							How Long	No. of Dependent Children
Employer	Position						How Long	Gross Monthly Income
Employer’s Address								Telephone
Previous Employer & Address								Telephone
Spouse				SSN				Date of Birth
Employer				Position		How Long			Gross Monthly Income
Employer’s Address									Telephone
Name & Address of Nearest Relative (Not in Household)					Relationship				Phone
Bank & Address		Telephone			Checking Account				Savings Account
Automobile		Year			Make				Model
Automobile		Year			Make				Model
Do You Receive Child Support or Alimony Payments?		_____Yes			_____No				Monthly Amount _________
Do You Receive Adoptive Child Assistance Payments?		_____Yes			_____No				Monthly Amount _________
Do You Receive Income From Other Sources?		_____Yes			_____No				Monthly Amount _________
Does Student have SSI, Inheritance, Trust Fund, Etc.?		_____Yes			_____No				Amount _________________
Are You Obligated to Make Alimony or Child Support Payments?		_____Yes			_____No				Monthly Amount _________
Have You Filed Bankruptcy or Chapter 13 Within the Last 10 Years?		_____Yes			_____No				If Yes, Mo/Yr ____________
Do You Now Have Any Unsatisfied Judgments Against You?		_____Yes			_____No				If Yes, Please explain on Other Side
Are You a Cosigner, Endorser, or Guarantor For Others?		_____Yes			_____No				If Yes, Please Explain on Other Side
Name & Address of Creditors					Amt Borrowed				Present Balance

FOR THE PURPOSE OF PLACING MY STUDENT AT NEW CREATIONS, I CERTIFY THAT THE ABOVE INFORMATION IS TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE. I AUTHORIZE YOU TO CHECK MY CREDIT AND EMPLOYMENT HISTORY. I HAVE INCLUDED THE REQUIRED DOCUMENTS (CHECK STUBS, LAST YEAR’S FEDERAL & STATE INCOME TAX RETURNS, VERIFICATION OF OTHER INCOME, ETC.) I AGREE TO NOTIFY NEW CREATIONS OF ANY CHANGES IN MY FINANCIAL STATUS.

Applicant Signature X ______________________________________________Date: __/__/____

Names of Dependant Children		Age	Date of Birth			Living at Home?	College?



Comments or Explanations From Previous Page




*FOR OFFICE USE ONLY*
				INCOME
				Income 1
Special Circumstances	Check if Yes			Income 2
Orphan?				Child Support
Death or Divorce?				Adoptive Support
Unemployment/Disability?				SSI, Insurance, Etc.
Low Income/Welfare Recipient?				Other Income
Full Time Ministry?				Total Income

Comments or Special Considerations					Dependants in Household _____________
				*APPLICATION APPROVAL*