1 P.O. Box 2576 * Mesa, Arizona * fax KIDS IN CRISIS GENERAL FUND Letter to Administrators It seems every year we encounter a few families in our program that suddenly experience a catastrophic and life changing event. Often times, the family is so consumed with the event and trying to adjust to the devastating losses that are incurred, that tuition payments become an afterthought or get forgotten all together. We understand, as administrators you hate having to ask a family already in crisis when you can expect the next tuition payment but you have to do it. It s the painful part of your job. Here at Arizona Scholarship Fund our hearts go out to these families and to you as administrators. In response to this very difficult situation, the ASF Board of Directors have established a special fund for administrators to apply to for students at their school who are experiencing a catastrophic event causing an inability to continue making tuition payments. The affected family must: have been able to make tuition payments at the beginning of the school year be current on their tuition payments be experiencing a specific, unforeseen circumstance they have no control over be financially severely affected 30%+ increase in expenses or decrease in assets If approved by majority vote of the Board Committee, this is a one-time payment for the current school year s outstanding tuition liability only. Historically, on-going financial hardships, tuition debt, loss of a secondary income, foreclosure of a home, etc. are examples of cases that do not qualify for assistance. The death, incapacitation, abandonment or unemployment of a family's sole bread winner, sudden loss of the primary residence due to acts of God, financial crimes resulting in a loss of more than 30% of a family's assets, sudden 30%+ increase in expenses, etc. are examples of cases that may meet the criteria of this fund. Administrators, if you have a student in sudden dire circumstances who needs assistance with tuition, please work with the parent(s) to complete the Kids in Crisis General Fund Application Packet. Once submitted, the Board Committee will review the packet and make a decision at the next regularly scheduled meeting. We are hoping to never have to use this general fund but if necessary, we may be able to assist when assistance is needed most. ChamBria J Henderson Executive Director
2 P.O. Box 2576 * Mesa, Arizona * fax Overview and Purpose Kids in Crisis General Fund Disbursement Policy Statement A Overview of Disbursement Policy Arizona Scholarship Fund (ASF) Kids in Crisis General Fund is a separate account established by Arizona Scholarship Fund, Inc. (An Arizona School Tuition Organization) for the benefit of Arizona students (in grades K-12 and including preschoolers with certain disabilities as defined in A.R.S ) whose families have recently experienced a catastrophic event that has made it difficult to fulfill their school tuition obligations. The Kids in Crisis General Fund consists of monies donated to the ASF General Fund and not to any sub-category general funds, community funds or family aid funds. The monies are intended to be catastrophic event based and no weighting will be given to academic or athletic ability or performance. The fund allows for ASF to pay all or a part of a student s tuition expense. The committee members and Board may amend this policy statement to comply with any state rules, regulations, laws and/or defined best practices. The Kids in Crisis General Fund monies are set apart at the discretion of the ASF Board and may not be available at all times or every year. Monies are awarded in accordance with ASF policy and all state and federal laws regarding the students' religious affiliation, race, creed and citizenship status. The responsibility for determining the amount of monies awarded to pay for each student s tuition belongs to the committee as a whole or simple majority. The Kids in Crisis General Fund committee members are appointed and serve at the discretion of the ASF Board Chairman. Committee members are responsible for: Assessing and determining whether a dire financial need exists Deciding how much to award each student Evaluating these procedures periodically The Committee has the obligation to, in accordance with already established and Board approved guidelines, determine the student s eligibility to apply for funds available through any other ASF or school specific fund in addition to seeking assistance through the Kids in Crisis General Fund. The ultimate authority to establish the dire needs criteria and guidelines, to prepare and amend this Disbursement Policy Statement and the ongoing evaluation of procedures, resides with the ASF Board. The Board may appoint specific committee members to fulfill those functions. The ASF Board, the committee members, as the case may be, is/are designated as the fiduciary(ies) for the monies and shall have the responsibilities and authority provided in this Disbursement Policy Statement.
3 B. Purpose of Disbursement Policy Statement The purpose of this Kids in Crisis General Fund Disbursement Policy Statement ( DPS ) is to establish the definition and criteria under which an application will be approved or denied. This will serve as a set of guidelines that will be subject to periodic evaluation, or monitoring, by the committee members and/or Board as a whole. These guidelines do not constitute a contract or a statement of mandatory requirements, but are instead an explanation of the general principles established for the awarding of monies. The committee or Board will determine the weighting to be given to each of these principles and may consider factors in addition to those described in these guidelines. This DPS explains how the Board will discharge its obligations to: Assess and determining whether a dire financial need exists Decide how much to award each student Evaluate these procedures throughout the year; and based on such periodic evaluations, determine whether or not to adjust the criteria or guidelines This DPS will also outline how the Board and committee members will: document and define the roles and responsibilities of all involved parties follow applicable confidentiality regulations and best practices follow a due diligence process to document dire needs candidates periodically review its own effectiveness in meeting responsibilities These guidelines will be reviewed informally at appropriate intervals and will be reviewed on a formal basis as circumstances warrant. C. Statement of Objectives This DPS has been arrived at upon consideration by the Kids in Crisis General Fund Committee and approved by the ASF Board of Directors. D. Definition of Dire need Definition: A dire need is one wherein a student who, at the time of enrollment, had the ability to pay for the tuition expenses but is currently unable to do so because of unforeseen circumstances. One whose reasonable available resources to pay tuition have run out due to an unforeseen catastrophic event. E. Guidelines and Criteria General criteria and definition: Confirmation that the student s application has been screened to determine their eligibility for other ASF or specific school funds (or is currently in the process of being screened). Demonstrated ability to pay tuition at the time student was enrolled. Either via income, assets, or other resources. Demonstrate current inability to pay tuition based on an unexpected catastrophic event that occurred after student enrolled. For example: loss of income, increased unseen hardship-related expenses, loss of assets, or loss of other resources.
4 Specific criteria necessary to determine eligibility: A parent or guardian must be able to demonstrate their ability to pay 100% of tuition costs at the time of enrollment. Determination of financial inability to pay: Unforeseen income reduction of 30% or more Unforeseen expense increase of 30% or more Usage of all currently available reasonable, resources to pay the remaining balance have proven incomplete. Assets or other resources, determined at the time of enrollment, have been eliminated or significantly reduced F. Documentation required at time of application Administrator Requirements Amount requested from ASF and any other STO or school funds Amount already paid from ASF funds; other STO or school funds Letter certifying that the student is currently enrolled, published annual tuition amount, the specific amount that is still owed and that it represents only tuition expenses for the current academic year, and that school officials haven t made any representations regarding the applicants eligibility for receipt of ASF funds (beyond any published general or specific guidelines) Parent requirements Hardship letter describing what has changed in the financial situation to be unable to afford tuition; must be submitted by the parent or guardian only. Income Verification Form with all sources of income documented Federal and State tax returns and any other financial documents as determined by the Kids in Crisis General Fund Committee. If applying for bankruptcy, a simple statement from attorney confirming such. Optional documentation: Any additional information, not specifically requested by the committee, that the candidates wish to provide to document current financial difficulties will be accepted
5 P.O. Box 2576 * Mesa, Arizona * fax KIDS IN CRISIS GENERAL FUND APPLICATION Consideration for disbursement of funds is on a "catastrophic and dire need" basis only and is a one-time funding during the current school year. Please complete the application and submit all information to ASF. The ASF Kids in Crisis General Fund Committee will review the application at the next Committee meeting. The applicant family MUST be registered with ASF. School Information - to be completed by an Administrator. Incomplete applications will not be considered. School Name Published Annual Tuition: $ Administrator: Is this student currently enrolled on a full time basis? Yes No Have school officials made any representations regarding the applicant's eligibility for receipt of funds? Yes No Tuition owed for current school year: $ Amount being requested from ASF: $ Other STOs: $_ Amount of tuition received from ASF: $ Other STOs: $_ Amount of tuition paid by parent: $ Family Information/Requirements to be completed by parent/guardian. Parent / Guardian Names: Phone: Student Name: Grade: ASF File #: To be submitted with this application: Complete federal and state tax returns (most current year) Income Verification Form with all documentation Letter from parent explaining the event / circumstances causing a "dire need" situation Date of Catastrophic Event: Type of Event: Event must be within the current school year (July 1 st - June 30 th ) I certify all information submitted in regards to this application is true and complete to the best of my knowledge and ability. I also understand that I may be contacted by ASF if there are further questions or information needed. Parent/Guardian Signature Date Parent/Guardian Signature Date Administrator Date ASF Office Use Only Committee Decision Approved [ ] Amt $ Denied [ ] Date: Instructions [ ] ASF Program Director Other Funds: Paid: $
6 P.O. Box 2576 * Mesa, Arizona * fax Income Verification Form Dear ASF Parent, This form is one part of the Kids in Crisis General Fund Application that will be submitted on your behalf. Please complete and submit this form to your school administrator along with the appropriate documentation of all household income received last month. All information will be verified. Incomplete or vague applications will not be considered. Parent Name: ASF File #: Mailing Address: City, State, Zip: Phone: 1. If you receive benefits from the Supplemental Nutrition Assistance Program (SNAP) or TANF, send a copy of one of the following: SNAP or TANF Certification Notice that shows dates of certification Letter from SNAP or Welfare Office that says you have received benefits Do not send your EBT card Complete section 4 (page 2) of this form 2. If the child is a Foster Child: Send official documentation from the agency sponsoring the child. Complete section 4 (page 2) of this form 3. If you do not receive SNAP or TANF for your children: Write the name of each household member below. Send this form along with all appropriate documentation showing the amount of money your household received last month from all sources. The documentation you send must show the name of the person who received the income, the date it was received, how much was received, and how often it is received. Acceptable documentation includes: o Jobs, tips, commissions, self-employment income: Paycheck stub or pay envelope that shows the amount and how often pay is received; letter from employer stating gross wages and how often they are paid; business ledgers are not acceptable. Statements, W2, federal and state tax documents are acceptable o Social Security, Pensions, Life Insurance or Retirement: Social Security retirement benefit letter, statement of benefits received, pension award notice, statement of life insurance proceeds regardless of the relationship of deceased to applicant, SSD or children under 18 SSI letters, Required minimum distribution taken from a deceased / inherited relative, income in respect of a decedent, 401k hardship withdrawal statement, Annuity, retirement plan distributions o Unemployment, Disability, or Worker s Comp: Notice of eligibility from State employment security office, check stub, or letter from Worker s Compensation. o Welfare, cash assistance, food stamps, Medicare: Benefit letter from welfare agency. o Child Support or Alimony: Court decree or statements, agreement, or copies of checks received. o Other income (such as: rental income, royalties, investment income, interest, dividends, sale of personal property, loans or gifts from family members, church, civic organizations, pro bono, etc.): Information that shows the amount received, how often it is received, and the date received. o No income: A brief note explaining how you provide for your household, and when you expect an income. Please include a list of your monthly expenses and how you met them last month. o Military Housing Privatization Initiative: Letter or rental contract showing that your housing is part of the Military Housing Privatization Initiative. Military Housing Allowance is excluded from income
7 4. Total Household Gross Income Amount and frequency Follow these instructions to report total household income from last month in the chart below. Column 1 Name: List the first and last name of each person living in your household, related or not (such as grandparents, other relatives, or friends). Only the person completing this form must list their social security number. You must include yourself and all adults and children living with you. Attach another sheet if necessary Column 2 TOTAL earnings from work last month before deductions / Frequency of pay o List the gross income each person earned from work. This is not the same as take-home pay. Gross income is the amount earned before taxes and other deductions. The amount should be listed on your pay stub, or your boss can tell you. o List how often you receive the paycheck; weekly, bi-weekly, twice a month, once a month, bonus, annual Column 3 Other income: List in separate columns the amount each person received last month from: o welfare, child support, alimony, pensions, retirement, Social Security, Worker s Compensation, unemployment, strike benefits, Supplemental Security Income (SSI), Veteran s benefits (VA benefits), disability benefits, regular contributions from people who do not live in your household, and ANY OTHER INCOME or gift of assistance from friends, family, church, community organization, nonprofit, etc. Column 4 Business Income: Report last month's net income for your family's use from : o self-owned business, farm, or rental income. o If you are in the Military Housing Privatization Initiative do not include the housing allowance. Column 5 Gross Monthly Income: Add together columns 2-4 Column 6 No Income: If the person does not have any income, check the NI box. MONTH REPORTING: HOUSEHOLD GROSS INCOME: $ 1) Parents/Guardians 2) Earnings/Frequency 3) Other/Frequency 4) Business/Frequency 5) Gross NI All Other Household Members 5. Signature: _Soc Sec #: Date: Privacy Act Statement: The Richard B. Russell National School Lunch Act Financial Application is the standard ASF uses to determine a family's income according to federal poverty guidelines; established on page of the Federal Register / Vol. 74, No. 58. If you choose not to complete the form, your child will not be eligible for assistance through Arizona Scholarship Fund. You must include the social security number of the adult household member who signs the application. The social security number is not required when you apply on behalf of a foster child or you list a Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance for Needy Families (TANF) Program or Food Distribution Program on Indian Reservations (FDPIR) case number or other FDPIR identifier for your child. Arizona Scholarship Fund will use your information for state reporting and demographic purposes only. We may share your information with auditors for program reviews and law enforcement officials to help them look into violations of program rules. Non-discrimination Statement: In accordance with Federal law and U.S. Department of Agriculture policy, Arizona Scholarship Fund is prohibited from discriminating on the basis of race, color, national origin, sex, age, or disability. To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, 1400 Independence Avenue, SW, Washington, D.C or call (800) or (202) (TTY). Arizona Scholarship Fund is an equal opportunity provider and employer. A.R.S Chapter 1503 C. NOTICE: A school tuition organization cannot award, restrict or reserve scholarships solely on the basis of a donor's recommendation. A taxpayer may not claim a tax credit if the taxpayer agrees to swap donations with another taxpayer to benefit either taxpayer's own dependent.
8 P.O. Box 2576 * Mesa, Arizona * fax Dear ASF Parent, You are receiving or have downloaded this packet because you may qualify for the Kids in Crisis General Fund. This fund is for families who had the ability to pay their child's tuition at the beginning of the school year and are current on their tuition payments but have experienced a catastrophic event that has caused an inability to pay the remaining balance. This fund does NOT cover on-going hardship cases. The packet contains the following forms: 1. Kids in Crisis General Fund Disbursement Policy - please read the policy outlining the criteria the Committee uses for determining whether to award funds or not. At the time of enrollment in the qualified school, the family had the ability to pay tuition The tuition is paid to current The family is experiencing one or more of the following situations within the current school year: sudden 30% reduction in income sudden 30% increase in expenses catastrophic event, including but not limited to the death, incapacitation or abandonment of the family s sole breadwinner 2. Kids in Crisis General Fund Application - please complete the parents' portion of the application. You will need to complete one form for each child. Your packet MUST include: IRS Form 1040 and all schedules submitted (extensions are not acceptable) Arizona State Form 140 Income Verification Form Documentation of all income received last month Detailed letter explaining the catastrophic event including the date of the event 3. Income Verification Form - please complete this form in its entirety showing all income for each member of your household for LAST MONTH. List ALL members of the household. Only the person completing the form needs to submit their social security number. Beside each person's name, please list the total amount of income or financial assistance they received LAST MONTH. List the frequency of the income from each source. (i.e. "annual", "quarterly", "monthly", "bi-weekly", "twice a month", "weekly", "daily") Please see the list of sources of income that must be declared. Sign and date the form and include proof of all income. If there was no income, please write a letter showing your expenses for LAST MONTH and how you met them. Submit your completed packet to your child's school administrator in a large envelope with the appropriate amount of postage attached and the ASF name and address on the mailing label: Arizona Scholarship Fund PO Box 2576 Mesa, Arizona ATTN: Executive Director / Kids in Crisis General Fund The school administrator will complete a brief section and forward the packet to ASF. The packet will be reviewed by the Kids in Crisis General Fund Committee at the next regularly scheduled meeting. If you have any questions about completing this form, please feel free to me at this address. I will be happy to walk you through the process. ChamBria J Henderson Executive Director