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Financial Assistance Application

First name*

Last name*

Email*

Phone*

Address*

Program You're Applying For*

Current Annual Household Income (net) $*

Current Annual Household Expenses

Amount of other support possibilities (family, friends, professional support, loans) in $. Please Explain.*

Assets (Checkings, and Savings)*

Liabilities (Credit Card, Debts)*

Liquid assets that could be used to help pay for the program: $*

What could you pay as an initial payment? *

On a monthly basis?*

Other thoughts about a payment plan?

Explanation of need for financial assistance:*

IRS 1040

Or mail a copy to the Student Finaancial Administrator, P.O. Box 4035 Overland Park, KS 66204-9998

Get in Touch

administrator@lifewaysnorthamerica.net

LifeWays North America,

PO Box 4035

Overland Park, KS 66204

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