Tuition Referral E-Form

Tuition Referral E-Form:

Referring Family:

1.
*

Name:

2.
*

Address:

3.
*

City:

4.
*

State:

5.
*

Zipcode:

6.
*

Phone number:

7.
*

Church Affiliation:

8.
*

Method of Reimbursement:

Tuition Credit to current school family account   Donation to the general scholarship fund
Donation to community congregation scholarship fund   Tithe/Offeration Donation to Grace Lutheran Church
Check Rebate

Family being referred:

9.
*

Name:

10.
*

Address:

11.
*

City:

12.
*

State:

13.
*

Zipcode:

14.
*

Phone number:

15.
*

Student(s) grade(s):

16.
*

Church Affiliation (if any):

* Email Address: