Weekly Word From St. Patrick School JANUARY 27, 2012

WEEKLY MESSAGE To kick off Catholic Schools Week, the Knights of Columbus will be On Sunday, we start Catholic sponsoring a pancake breakfast. This Schools Week. I am truly proud to be will be held on Sunday, January 29 an administrator in the Archdiocese of starting at 9:00 and will end at 12:00. Dubuque Catholic School System. The cost is a free‐will donation. Most of all, I am proud to be an administrator for St. Patrick School. CANDY BAR SALES The first thing that I noticed when I began over a year ago was the Candy bar sales have begun. In difference in environment. Coming order to have a box to sell, you will from a public school system, I noticed need to sign one out. You can also that the students of this school are in a check one out through email or more positive place. The great part verbally. We will only give out boxes about that is it seems to be a common of candy bars if we hear from the theme in every Catholic School. Every parents. This will help us keep track school that I visit for meetings, I notice of the boxes of candy bars. the same environment. It is truly great to be part of a great educational VIP DAY opportunity where Christ is at the center. We will only continue to get One of our days for Catholic better. Just like I tell the students of Schools Week is VIP Day. The form is this school, just enough is not good attached to the newsletter. Please enough. We need to continue to grow read it carefully. academically, socially, become better citizens, and most of all; live the STO teachings of Christ. This is also an opportunity for everyone to spread I have attached the STO the word about St. Patrick School. I application. The STO program is for encourage everyone to tell people students going into kindergarten how great our school is. Let’s set a through sixth grade. It is used to goal of increasing our enrollment by make a Catholic education affordable 10 students. Let’s fill our classrooms, for all. I am also sending out a paper and get to the point where there is a copy of the application. Please waiting list for our school. The best remember, if you fill out an electronic recruiters of our school are parents. version of the application, you will still God bless everyone and God bless St. need to mail it to PSAS. The only way Patrick School. it will be sent electronically is if you fill out the application online at PANCAKE BREAKFAST www.psas.org.

VIP Day

Dear Parents:

During Catholic Schools Week, we have had a day called Very Important People Day. We wanted to call it that, because we feel that all people who visit are important. Any important person in your child’s life is invited. This day will be on Friday, February 3. Below, you will see a schedule of that day, menu, and other information that is important. Please pay close attention to the “Other Information” section.

Schedule

9:30 VIPs can arrive 10:30 Mass 11:20ish First Lunch 11:50 Second Lunch 12:30 Early Dismissal

Menu

Roast Turkey Mashed Potatoes and Gravy Corn Roll and Butter Cherry Cake Milk

Other Information • January 30: Permission Slip and Count for Number of People Coming Due • Lunch cost: $3.00 per Adult, $2.00 for children coming with VIPs • Money for Lunch due by February 2 • Children can’t leave with people other than parents without form filled out. • If children are leaving with the VIP, they must let the teacher know, and sign out in the office.

Permission Slip

Child’s Name:______

Child’s Grade:______

I give my child permission to go home with ______on Friday February 3.

______Parent/Guardian

Count of People Coming

Child’s Name:______

Child’s Grade:______

Name of People Coming: ______

Telephone: 319-462-2688 • E-Mail: [email protected] • Internet: www.stpat-anamosa.pvt.k12.ia.us

Sr. Susan Dunnwald, R.S.M. Dear Parent/Guardian, Pastoral Administrator

The Our Faith, Our Children, Our Future School Tuition Organization (STO) and St. Chris Frimml Patrick School are pleased to once again provide tuition assistance to qualifying Principal families. This program, supported by over 1,000 donors provides expanded opportunities to help qualifying families afford the Catholic School of their choice.

Steve Reyhons Tuition assistance through the Our Faith, Our Children, Our Future STO is available to School Board all families whose 2011 taxable income is at or below 300% of the federally President determined poverty rate. That table is found at the end of this letter.

Jerry Rogers Both the Our Faith, Our Children, Our Future STO and St. Patrick School will be utilizing School Board Private School Aid Services (PSAS) to assist in determining the level of assistance to Vice President be awarded. PSAS has developed an application that all families need to complete to be considered for assistance. Your personal information will be held in strictest confidence at all times. If you have a child at more than one Archdiocesan School, you Aimee Scranton will only need to complete one application form. There is a $22 non‐refundable School Board Secretary processing fee for the application, payable to PSAS. Please note this is a one‐dollar increase from last year.

John Fahey The application is available at the school office and on line at www.psas.org. If you Dean Koopmann contact the school office we can provide a form to you. In addition to your completed Jeremy Neuhaus application, you must include a copy of your 2011 federal income tax return or your School Board 2010 federal income tax return with a copy of your 2011 W‐2(s). The application Members needs to be completed on‐line or via U.S. Mail, postmarked no later than March 23, 2012. Jackie Foster Office Manager To assist you in filling out the application PSAS will have a call center available at 1‐866‐424‐6443. The call center is open Monday‐Friday from 11:00 am‐7:00 pm, and on Saturdays from 8:00 am‐noon. You are also welcome to call St. Patrick School at the school for assistance.

Award notification letters will be mailed on or before May 21, 2012. The complete timeline with specific information concerning the application is found below.

We strongly encourage every family to complete an application. The Our Faith, Our Children, Our Future STO will be able to make Catholic Education affordable for all.

If you have questions about the assistance program, call the school. Call the PSAS call center at 1‐866‐424‐6443 with specific questions about the application. This is a wonderful opportunity for qualifying families.

Sincerely,

St. Patrick School Principal

Timeline

January Applications available through the school and on‐line at www.psas.org. March 23 Completed applications must be post‐marked or filed electronically. May 21 Award notification letters sent to all families who applied. May 31 Families receiving assistance send confirmation they are accepting/declining the assistance back to the school. School Code When completing the application, our school/system code is 3214. The password online is Arch1.

Program Information

The Our Faith, Our Children, Our Future STO is funded by numerous generous donors from across the Archdiocese of Dubuque. All donors received an Iowa Tax Credit equal to 65% of their gift, with all donations qualifying for a federal income tax deduction for their 2011 returns. Donors interested in contributing to this program during 2012 can download a donor application at www.OurFaithSTO.org. The goal for 2012 is to raise $4.265 million to be used in the 2013‐14 school year.

Families are eligible for the Our Faith, Our Children, Our Future STO assistance if their taxable income for 2011 is at or below 300% of the poverty level. The poverty level is set by federal guidelines. The level of Our Faith, Our Children, Our Future STO assistance recommended by PSAS will be based upon family income, number of dependants, and the total K‐12 tuition bill for the family.

*STO Qualifying Levels 2012­2013 **Family Size ***Maximum Income **Family Size ***Maximum Income Two $45,390 Five $81,030 Three $57,270 Six $92,910 Four $69,150 Seven $104,790 * STO qualifying levels are based upon 300% of 2012 Federal Poverty Levels as required by Iowa law. **Family size includes parents/guardians plus total number of dependents claimed on 2011 tax return. For families with more than seven persons, add $11,880 for each additional person. *** Families are eligible for STO assistance if their taxable income is at or below the above listed income levels. Local assistance may not be based upon the above. Falling within these guidelines does not necessarily guarantee tuition assistance.

All families who want to be considered for tuition assistance must fill out the PSAS application.

PARENT NAME Student Aid Form 2012 - 2013

Our Faith, Our Children, Our Future School Tuition Organization S. T. O. Help Desk at 1-866-424-6443

Application Conditions: Directions: = This Student Aid Form (SAF) is used to determine financial need = One application is to be filed per family even if dependents attend for the Our Faith, Our Children, Our Future School Tuition more than one school. Organization. = All applications are to be returned to PSAS sealed in the envelope = Student(s) must live in Iowa for S.T.O. funding. provided. = Local assistance is open to all students, including those = If you need assistance completing the application, please contact residing outside of Iowa. Please speak with your local school the S.T.O. helpdesk at 1-866-424-6443. administrator to determine if local tuition assistance is available, in addition to STO assistance. = Incomplete Applications cannot be processed. STUDENT NAME This form must be postmarked no later than march 23, 2012. TO COMPLETE THIS APPLICATION YOU WILL NEED TO INCLUDE:

Please note: This application requires documentation for income received in 2011. 1. Detailed copies of all pages and Schedules of your 2011 Federal Income Tax Return Form 1040, 1040A, or 1040EZ (as filed with the IRS) for individuals listed in Sections A and B. Recaps and/or Summary Forms are not acceptable. If you file Schedule(s) A, C, E, or F, you must provide copies. If you have not yet filed, or are not required to file a tax return, see the REQUIRED DOCUMENTATION section of the INSTRUCTIONS. 2. Copies of all 2011 W-2 Wage and Tax Statement Forms, all 2011 1099/1099R for Interest/ Dividends, Pensions/Annuities and/or Misc. Income Forms for individuals listed in Sections A and B (Please make sure all documentation is copied on regular 81/2 x 11 paper - documentation cannot be returned). 3. Documentation of TOTAL AMOUNTS received in 2011 for all Non-Taxable Income (see Section G for specific requirements). 4. Check or Money Order payable to PRIVATE SCHOOL AID SERVICE for the non-refundable application fee of $22.00 (All returned checks will incur an additional fee of $25.00). 5. This application form filled out in its entirety, signed and dated by the individuals listedin Sections A and B. 6. Please review pages 5 and 6 for explanations/directions as you complete this form. IMPORTANT: If the above items do not accompany this application, your application will not be considered complete. Keep a copy of this completed application and all documentation for your records. To check the processing status of your application, go to www.psas.org. Form #148 (2011) 1 Form #148 (2011) Student Aid Form = 2012 - 2013 = IMPORTANT: Print clearly and neatly with a blue or black ball point pen = Parent, Guardian, or Other Adult Parent, Guardian, or Other Adult A Responsible for Tuition B Residing with Parent A Check One: m Father m Mother m Step-Father m Step-Mother m Other Adult Check One: m Father m Mother m Step-Father m Step-Mother m Other Adult

Last Name First Name M.I. Last Name First Name M.I.

( ) ( ) Social Security Number Age (Area Code) Home Phone Social Security Number Age (Area Code) Home Phone

Address Apt. # COUNTY OF RESIDENCE Address Apt. # COUNTY OF RESIDENCE

City State Zip Code City State Zip Code

( ) ( ) (Area Code) Work Phone E-mail Address (Area Code) Work Phone E-mail Address

May PSAS contact you at work if May PSAS contact you at work if Employed by How Long? there are questions? m Yes m No Employed by How Long? there are questions? m Yes m No m If you are self-employed, please check and refer to Section K of this form. m If you are self-employed, please check and refer to Section K of this form. C Dependents (DO NOT LEAVE BLANK) Number of dependent children who will attend a tuition charging school: daycare, Pre-K, elementary school, secondary school, or college in the fall of 2012? Please list all dependent children in order of oldest to youngest, including college students. Indicate each dependent’s relation to Parent/Guardian A: child, foster child, grandchild, etc.

Name of school student plans to attend Tuition Relation Grade in Applying for Amount I/We School/ Dependent Dependent in the Fall of 2012 Aid? feel I/We can charged M.I. Age to Parent/ the fall System Last Name First Name DO NOT ABBREVIATE check one pay toward yearly per Guardian A of 2012 Code* City and State Yes No tuition? student?

School Name 1 m m City and State

School Name 2 m m City and State

School Name 3 m m City and State

School Name 4 m m City and State

School Name 5 m m City and State m Please check if additional dependents are listed on a separate sheet. *Refer to School/System Code List D Household Information 1. Number of individuals who will reside in my/our household during the 2012-2013 2. Current marital status/housing arrangement of Parent/Guardian A: school year: m a. Single, never Married* m d. Divorced* m g. Residing w/Significant Other

Parents/Guardians Children Other* m b. Married m e. Remarried* m h. Other: m c. Widowed m f. Separated* *If , please explain Other *If Single, Divorced, Remarried, or Separated, please complete Section E. E Single, Divorced, Remarried, or Separated Parents (To be completed by the Parent/Guardian listed in Section A) 1. Date of separation (Month/Year) 5. Who claimed student as a tax dependent in 2011? 2. Date of divorce (Month/Year) 6. Who is responsible for the tuition for the dependent(s) listed in Section C? 3. Non-custodial parent q Father % Name Last Name First Name M.I. q Mother % Name 4. Do you receive or pay child support? q Receive $ Per year q Pay $ Per year q Other % Name * Form #148 (2011) q Neither 2 *If tuition is shared, each responsible party must complete a Student Aid Form (SAF). F Taxable Income G Non-Taxable Income The 2011 federal tax return for student’s household was: List the total amount received from 1/1/11-12/31/11 for all recipients in the household. m Filed DO NOT list monthly amounts. m Not filed yet (SeeRequired Documentation section) 10. Child Support $ per year m I/We do not file. I/We only receive non-taxable income 11. Cash Assistance (TANF) $ per year* Actual 2011 Estimate 2012 12. Food Stamps and/or W.I.C. $ per year* 1. Total number of exemptions claimed on Federal a. Medicaid received in 2011? m Yes m No Income Tax form. 13. Social Security income (SSA/SSD, etc.) 2. Parent/Guardian A total taxable income from W-2 (Provide documentation for all recipients in household.) $ per year* wages. (Total income for Parent A only) $ $ a. Social Security income (SSI Only) 3. Parent/Guardian B total taxable income from W-2 Total received in 2011 $ * wages. (Total income for Parent B only) $ $ (Provide documentation for all recipients in household.) 4. Net business income* from self-employment, farm, 14. Student loans and/or grants received for PARENT’s education rentals, and other businesses. (*Go to Section K) (Not college attending dependents or students listed in Section C.) (Attach Schedules C, E, and/or F from your IRS a. Total received in 2011 1040) See 2011 1040 lines 12, 17, and 18 $ $ $ * 5. Other non-work taxable income from interest, b. Total used for household expenses $ per year* dividends, alimony, unemployment, and non- 15. Housing Assistance (Sec. 8, HUD, etc.) business income. See 2011 1040 lines 8a, 9a-11, 13, $ per year* 14, 15b, 16b, 19-21; See 2011 1040A lines 8a-14b $ $ a. Religious Housing Assistance 6. Allowable “Adjustments to Income” as reported on (parsonage, manse, etc.) your IRS 1040, 1040A, or 1040EZ. Total received in 2011 $ * See 2011 1040 line 36 or 1040A line 20 $ $ 16. Other non-taxable income (Working for cash, Adoption and/ or Foster Subsidy, Worker’s Comp., Disability, Pension/ 7. Total “Adjusted Gross Income” as reported on your Retirement, etc. Identify source(s) in Section L) IRS 1040, 1040A, or 1040EZ. $ per year* See 2011 1040 line 37 or 1040A line 21 $ $ a. Any and all Military/VA Benefits and/or Compensation 8. Total Tax Paid as reported on your IRS 1040, Total received in 2011 (Identify source(s) in Section L) $ per year* 1040A, or 1040EZ. See 2011 1040 line 61 or 1040A 17. Loans/Gifts from friends or relatives $ per year line 35 $ $ 18. Personal Savings/Investment Accounts used for household 9a. Medical/Dental expenses as reported on Schedule expenses (Do not include totals listed in Section I) $ per year A, line 1 of your IRS 1040 form. $ $ 19. Total non-taxable income for 2011 $ per year 9b. Charitable Contributions as reported on Schedule *You must provide 2011 YEAR-END documentation for items 11-16a; either a YEAR-END Statement A, line 19 of your IRS 1040 form. $ $ from the appropriate Public Agency, or documentation showing totals from 1/1/11-12/31/11. H Housing Information (DO NOT LEAVE BLANK) I Assets & Investments (Current Values) 20. Do you rent or own your residence? m Rent m Own (go to line 22) 23. Total amount in cash, checking, and savings accounts $ 24. Total value of money market funds, mutual funds, 21. If renting, what is the monthly rental payment? $ stocks, bonds, CDs, or other securities $

a. Amount paid by household $ per month 25. Total value of IRA, Keogh, 401K, SEP, or other retirement accounts $ b. Amount paid by other source(s) $ per month a. What was your total contribution to your retirement account(s) in 2011 (IRA, Keogh, 401K, SEP, etc.)? $ c. Are you current on your monthly payment? m Yes m No 26. If you own real estate other than your primary residence: If No, what was the total amount paid in 2011? $ a. What is the fair market value? $

22. If you own a residence: b. What is the amount still owed? $ 27. Do you own a business? m m a. What is the current market value? $ Yes No If Yes, please go to Section K. b. What is the amount still owed, including a. What is the fair market value of your business? $ home equity loans? $ b. What is the amount still owed? $

c. What is the monthly mortgage payment? $ per month 28. Do you own a farm? m Yes m No If Yes, please go to Section K. d. Are you current on your monthly payment? m Yes m No a. What is the fair market value of your farm? $ If No, what was the total amount paid in 2011? $ b. What is the amount still owed? $ J Unusual Circumstances (Check all that apply to your situation within the past 12 months) q a. Loss of job q e. Bankruptcy q i. Death in the family q m. Medical/Dental expenses q b. Recent separation/divorce q f. College expenses q j. Shared custody q n. Shared tuition q c. Change in family living status q g. Income reduction q k. High debt q o. Other (explain in Section L) q d. Change in work status q h. Illness or injury q l. Child support reduction Office Use Only STO H T AG Keep a copy of this completed application and all documentation for your records. To complete Sections K, L and M go to the next page 3 Parent/Guardian A: SS#: Print Name Business Income Estimate (2011 Totals) K (If you have not filed your 2011 Tax Return, and are Self-Employed, own a business, rental property, and/or farm - DO NOT LEAVE BLANK) Schedule C Schedule E Schedule F

1. What is your total estimated GROSS business taxable income? $ $ $

2. What is your total NET business taxable income/loss? (DO NOT LEAVE BLANK) $ $ $

3. If your business pays your home rent or mortgage, what is the annual total? $

4. If your business pays for your personal automobile, what is the annual total? $

5. If your business pays any portion of other personal expenses, list total amount and explain in Section L. $

6. If you own rental property: What was the total amount of Rental Income received? $ L Explanations (Use this space to explain any answers which may need clarification.)

M Certification, Authorization, and Documentation Requirements WHAT IS REQUIRED TO PROCESS THIS APPLICATION (IF ANY OF THE FOLLOWING IS MISSING, YOUR APPLICATION WILL NOT BE CONSIDERED COMPLETE.) 1. This application form filled out in its entirety, SIGNED AND DATED BELOW by the Parent(s)/Guardian(s) listed in Sections A and B. 2. A check or money order made payable to PRIVATE SCHOOL AID SERVICE in the amount of $22.00. This is a non-refundable application fee. 3. If you have filed a 2011 If you have not yet filed a 2011 If you do not file an IRS IRS Form 1040: IRS Form 1040: Form 1040 AND receive only non-taxable income: A complete photocopy of your 2011 A complete photocopy of your most recent Form 1040, 1040A, Form 1040, 1040A, or 1040EZ (as filed or 1040EZ (as filed with the IRS, with all Schedules). 2011 Photocopies of your 2011 YEAR-END Social Services W-2 Forms, 2011 1099/1099R, or 1098 Forms for any wage- statement (TANF, etc.). Food Stamp documentation, with the IRS, including all Schedules). earning adult residing with the applicant(s). If this application Housing Assistance documentation, Student Loans and/ 2011 W-2 Forms, 2011 1099/1099R, is submitted after April 15, 2012, you must provide a copy of or grant documentation for parent’s education, Social or 1098 Forms for any wage-earning the 2011 Extension for Filing Request, as approved by the Security income statements showing TOTAL AMOUNTS adult residing with the applicant(s). IRS and a copy of your last filed tax return. received in 2011 for ALL members of the household. SIGN HERE I/We declare that the information on this form is true, correct, and complete to the best of my/our knowledge. I/We authorize PRIVATE SCHOOL AID SERVICE to return this form and all attachments only to the schools and agencies named in Section C under contract with PSAS.

Parent/Guardian A Date Parent/Guardian B Date This Student Aid Form (SAF), all attachments and an analysis of your SAF are sent only to the school(s) or agencies contracting with PSAS. You will not receive results from PSAS. No other agency will see or receive any information about this application or its attachments.

Mail completed application and photocopies of all documentation to: PRIVATE SCHOOL AID SERVICE, P.O. BOX 89434, CLEVELAND, OH 44101-6434 Questions? Call: (440) 892-4272 Copyright © 2011 Private School Aid Service 4 INTRODUCTION Single, Divorced, Remarried, or E Separated Parents PRIVATE SCHOOL AID SERVICE (PSAS) is under contract with the If dependent(s) parents are divorced or separated, or do not reside in school, school system, or organization from which you obtained this the same household, the custodial parent must provide the information application for tuition assistance. Our purpose is to provide a reasonable requested in Section E about the non-custodial parent. assessment of the ability of each family to pay for the education of their If the date of separation took place in the year 2011, PSAS will children at private and independent elementary and secondary schools. require copies of any tax returns filed jointly or independently by both parent(s)/guardian(s) for 2011. Be sure to estimate the income Your Student Aid Form, all attachments, and an analysis of your SAF in Section F for 2012. are sent only to the school(s) or agencies contracting with PSAS. No other agency will receive any information about this application or ITEM 4: List the total amount of child support actually received by its attachments. custodial parents listed in Sections A & B. If total received differs from court ordered amount, list only the total received. PRIVATE SCHOOL AID SERVICE does not make any decisions about ITEM 6: Indicate who is responsible for tuition and what percentage for recipients and amounts of financial aid awarded. Recipients and amounts the dependents listed in Section C. of aid are determined by the designated school or agency. YOU WILL NOT RECEIVE RESULTS FROM PRIVATE SCHOOL AID SERVICE. F Taxable Income INSTRUCTIONS List all actual amounts for 2011 and estimated amounts for 2012. ITEM 1: Enter the total number of exemptions you claimed on your 2011 A & B Parent, Guardian, or Other Adult IRS Form 1040, 1040A, or 1040EZ. This form should be filled out by the parent, guardian or other adult ITEM 2: Enter the total 2011 taxable income earned in wages, salaries responsible for the tuition of the child or children attending a private or and tips for parent/guardian/other listed in SECTION A. Attach all copies independent school contracting with PSAS. If the parents/guardians are of 2011 W-2 forms and/or 2011 1099 forms from all employers. divorced or separated, only the parent responsible for the tuition and any ITEM 3: Enter the total 2011 taxable income earned in wages, salaries other adult residing in the household should fill out the form. If tuition and tips for parent/guardian/other listed in SECTION B. Attach all copies is shared, each responsible party must complete a Student Aid Form of 2011 W-2 forms and/or 2011 1099 forms from all employers. (SAF) if financial aid is needed. ITEM 4: Enter the total net income from business (attach Schedule C Answer all questions for both parent(s), stepparent(s), or guardian(s) or C-EZ), all rents, royalties, partnerships (attach Schedule E), and all responsible for tuition for the dependent(s) listed in Section C. Do not farm income or loss (attach Schedule F). If you have received income If natural parents are divorced, separated leave any questions blank. from any of these sources and are estimating your income for 2011, you or single, answer all questions in Section E. If natural parents are must also fill out Section K of this application. (See 2011 1040 lines 12, divorced/separated and remarried, list information for custodial parent 17, and 18, enter sum total.) and new spouse. If either parent answers “self-employed,” and has not filed a tax return, complete Section K. ITEM 5: Enter the total of all other taxable income from interest, dividend income (attach Schedule B if over $400), taxable refunds, credits or CALCULATIONS ARE BASED ON TOTAL HOUSEHOLD INCOME. offsets of state and local income taxes, alimony received, capital gain or loss (attach Schedule D). List all capital gain distributions not previously Student Information reported, total IRA distributions (if rolled-over, explain in Section L), C pensions and annuities, unemployment compensation, taxable social List all dependent children residing in your household in order of oldest security benefits, and any other taxable income. Attach copies of to youngest. Indicate the relation to Parent/Guardian A listed in Section all Form 1099/1099R, and/or Form 1098 for Interest/Dividends, A of the application (i.e. child, grandchild, foster child, stepchild, etc.). If Pensions/Annuities or other misc. income. Attach copies of Social your dependents will be enrolled in any tuition charging school or agency Security Income statements and Unemployment Compensation next fall (including daycare, preschool, elementary school, high school, documentation for year-end 2011. (See 2011 1040 lines 8a, 9a-11, 13, college, or trade school), list the name of the school, city and state where 14, 15b, 16b, 19-21, or 1040A lines 8a-14b, enter sum total.) the school is located. List the grade your child(ren) will enter next fall (2012-2013); the amount you feel you can pay toward tuition per year, and ITEM 6: Enter allowable adjustments to income, such as IRA payments, the amount of tuition charged per student per year. self-employment tax, self-employed health insurance deduction, Keogh retirement plan and self-employed SEP deductions, penalty on early If “No” is checked for a student listed in Section C, that student will not savings withdrawals, and alimony paid. Add together to arrive at your be considered for tuition assistance. For all additional dependents, use total adjustments. DO NOT include your standard deduction or deduction a separate sheet. amounts for each family member. (See 2011 1040 line 36, or 1040A line 20.) NOTE: The information regarding tuition charged per student assists PSAS in making the most equitable analysis of your ability to pay for ITEM 7: Enter total adjusted gross income as reported on your IRS private education. If you are unsure, please estimate. Form 1040, 1040A or 1040EZ. Attach all pages of the applicable tax form (1040, 1040A, 1040EZ) for documentation. (See 2011 1040 line Household Information 37, or 1040A line 21.) D ITEM 8: Enter the Total Tax paid (not withheld) as reported on your ITEM 1: Enter total number of individuals living in the household. Include IRS Form 1040, 1040A, or 1040EZ. (See 2011 1040 line 61, or 1040A any college students claimed on the tax return. Do not include children line 35.) who have moved out of the home. Include all family members dependent on and residing with the parent listed in Section A. ITEM 9a: Enter the total of any medical and dental expenses as reported on Schedule A, line 1 of your IRS Form 1040 (attach Schedule A). ITEM 2: Check the appropriate box indicating custodial parents’ marital status. If parents are single, divorced, remarried, or separated, complete ITEM 9b: Enter the total amount of Charitable Contributions as reported Section E. on Schedule A, line 19 of your IRS Form 1040 (attach Schedule A). Keep a copy of this completed application and all documentation for your records 5 G Non-Taxable Income J Unusual Circumstances If you receive non-taxable income, you must list and provide documentation Check any and all items that apply to your situation. If your circumstances require of the TOTAL YEARLY AMOUNTS received in 2011 for all recipients in the household for the following: Cash Assistance (TANF), Food Stamps, Social explanation beyond the scope of this application, please notify the school to which Security income, Student loans and/or grants (received for PARENT’s education), you are applying and also include a letter of explanation with this application. Housing assistance (Section 8, HUD, etc.), Worker’s Compensation, Disability or Retirement. Business Income ITEM 10: Child support: Report total amount received for 2011 for all children in the household. K Provide 2011 Business Income Estimates if you have not filed your 2011 Report total amount received for . ITEM 11: Cash Assistance (TANF): 2011 Tax Return. Report total amount received for . ITEM 12: Food Stamps and/or W.I.C.: 2011 ITEM 1: List estimated total GROSS taxable business income for 2011. Do not combine with TANF or Medicaid. ITEM 2: List estimated total NET taxable business income/loss for 2011. ITEM 12a: Did you receive Medicaid in 2011? ITEM 3: List the total amount paid by business in 2011 for home rent or mortgage. ITEM 13: Social Security benefits: Report the total non-taxable (SSA/SSD, etc.) amount received in 2011 for all recipients in household. ITEM 4: List the total amount paid by business in 2011 for personal automobile. ITEM 13a: Social Security benefits: Report the total non-taxable (SSI ONLY) ITEM 5: List the total amount of personal expenses paid by business in 2011 that amount received in 2011 for all recipients in household. do not fall into one of the categories above. ITEM 14: Student loans and/or grants: Report the total amount received in ITEM 6: List total amount of estimated rental income received in 2011. for PARENT’S education. Do not list loans, grants or scholarships received 2011 If providing income estimates for more than one business, corporation or farm for dependents in Section C. Identify how much of this income was used for household expenses in 2011. (Schedule C, Schedule E and/or Schedule F) please list information for each ITEM 15: Housing assistance: Report the total amount received for 2011. business, corporation or farm separately. Use additional sheet or Section L, if Identify in Section L all sources of Housing assistance (government assistance, necessary. Section 8, HUD, family/friends or other sources), including monies received toward rental/mortgage payments and/or utilities. ITEM 15a: Religious Housing assistance: Report the total amount received Explanation for . L 2011 If any specific question requires clarification, write a brief explanation in this space. Report all additional non-taxable income ITEM 16: Other non-taxable income: If your circumstances require explanation beyond the scope of this application, received in 2011 including: Working for cash, Deductible IRA or Keogh payments; untaxed portions of pensions; tax exempt interest income; foreign income please notify the school to which you are applying. exclusion; Workers’ Compensation; cash support or any money paid on your behalf, including support from a non-custodial parent or any other person (do Certification, Authorization, and not include court ordered support here); adoption and/or foster care subsidy, or Documentation Requirements any other benefit or income not subject to taxation by any government (Refugee M You sign the form in this section. Your signature authorizes PSAS to release Assistance, etc.). Identify source(s) in Section L. must the form and attachments to the contracting schools indicated in Section C. By ITEM 16a: Any and all Military/VA Benefits and/or Compensation: Provide your Leave and Earnings Statement (if applicable) and report the total amount signing the form, you also certify that the information submitted is correct. This received for 2011 of food and other living allowances paid to members of application CANNOT be processed without the appropriate signature(s) and the the military, veterans non-education benefits (Death Pension, Dependency appropriate documentation. and Indemnity Compensation, etc.), VA Educational Work-Study, etc. Identify source(s) in Section L. If you have filed your 2011 IRS Form 1040: ITEM 17: Loans/Gifts received from friends or relatives: Report the total REQUIRED DOCUMENTATION amount received in 2011. ITEM 18: Personal Savings/Investment Accounts: Report the total amount If you have filed your 2011 IRS Form 1040: used in 2011 for household expenses. You must submit photocopies of all pages of your 2011 Federal Tax Return Form ITEM 19: Total non-taxable income for 2011: Add together Items 10-18. 1040, 1040A or 1040EZ (as filed with the IRS, with all Schedules, 2011 W-2 Housing Information Forms, 2011 1099/1099R, or 1098 Forms for any wage-earning adult residing with H the applicant(s). Do not include your State tax return unless requested. ITEMS 20 and 21: If you rent your home or apartment, list your monthly rental If you have not filed your 2011 IRS Form 1040: or lease payment here, including amounts paid by household and other sources. ITEM 21c: Indicate whether you are current on your monthly rental payment and You must submit photocopies of all 2011 W-2 Forms, 2011 1099/1099R, or 1098 if not, what the actual amount was that you paid in 2011. Forms for any wage-earning adult residing with the applicant(s), and photocopies ITEM 22a: Determine the present value of the family home and list it. Local real of all pages of your most recent Federal Tax Return Form 1040, 1040A or 1040EZ estate agents should be able to help you if you are unsure. (as filed with the IRS, with all Schedules). If this application is submitted after Check with your lending institution and enter the amount still owed, ITEM 22b: April 15, 2012, you must provide a copy of the 2011 Extension for Filing including second mortgages. Request, as approved by the IRS. ITEM 22d: Indicate whether you are current on your monthly mortgage payment and if not, what the actual amount was that you paid in 2011. If you are an Independent Contractor or self-employed and have not filed your 2011 IRS Form 1040: Assets and Investments I You must complete Section K and submit photocopies of all pages of your most ITEM 23: List total of current balances in cash, savings, and checking accounts. recent Federal Tax Return Form 1040, 1040A or 1040EZ (as filed with the IRS, Do not include IRAs or Keoghs. with all Schedules), 2011 W-2 Forms, 2011 1099/1099R, or 1098 Forms for any ITEM 24: List total current market value of money market funds, mutual funds, wage-earning adult residing with the applicant(s). If this application is submitted stocks, bonds, CDs or other securities. after April 15, 2012, you must provide a copy of the 2011 Extension for Filing ITEM 25: List total current market value of all retirement funds, including IRA, Keogh, 401K, and SEP plans or other retirement accounts. List total amount Request, as approved by the IRS. contributed in 2011 for Item 25a. If you receive non-taxable income: ITEM 26: Answer Items 26a and 26b for any and all investment real estate (not including the family’s primary residence), if applicable. Second homes, rental You must submit photocopies of your 2011 YEAR-END (01/01/11 - 12/31/11) properties, and land contracts should be included. Cash Assistance documentation (TANF, etc.), Food Stamp documentation, ITEM 27: If you own a business, check the Yes box and answer Items 27a Housing Assistance documentation, Student loan and/or grant documentation (for and 27b. If you have not filed your 2011 tax return, complete Section K of this application. PARENT’s education), Social Security Income statements, showing the TOTAL ITEM 28: If you own a farm, check the Yes box and answer Items 28a and 28b. AMOUNT received in 2011 for ALL members of the household. If you list any total If you have not filed your 2011 tax return, complete Section K of this application. for line 16, you must identify source(s) in Section L. Our Faith, Our Children, Our Future Student Tuition Organization SCHOOL CODE / SYSTEM CODE LIST

City (Main Office) School Name Grades Code Ames...... St. Cecilia School...... K-5...... 3261 Anamosa...... St. Patrick School...... K-6...... 3214 Bellevue...... Marquette System...... K-12...... 3262 Calmar...... C/F/S Consolidated School...... K-8...... 3460 Cascade...... Aquin Elementary School...... K-8...... 3461 Cedar Falls...... St. Patrick School...... K-8...... 1667 Cedar Rapids...... All Saints School...... K-5...... 1813 Cedar Rapids...... Holy Family System...... K-8...... 1143 Cedar Rapids...... Regis Middle School...... 6-8...... 3265 Cedar Rapids...... St. Matthew School...... K-5...... 3267 Cedar Rapids...... St. Pius X/St. Elizabeth Ann Seton School... K-5...... 3465 Cedar Rapids...... Xavier High School...... 9-12...... 1407 Charles City...... Immaculate Conception School...... K-6...... 3466 Cresco...... Notre Dame Elementary School...... K-6...... 3216 Decorah...... St. Benedict School...... K-8...... 4602 Dubuque...... Holy Family Catholic Schools...... K-12...... 3467 Dyersville...... Beckman High School...... 7-12...... 3244 Dyersville...... St. Francis Xavier School...... K-6...... 3245 Farley...... Seton Catholic System...... K-8...... 3471 Gilbertville...... Bosco System...... K-12...... 3268 Guttenberg...... St. Mary School...... K-8...... 3247 Holy Cross...... LaSalle Catholic School...... K-8...... 3472 Independence...... St. John School...... K-8...... 3270 Jesup...... St. Athanasius School...... K-8...... 3473 Manchester...... St. Mary School...... K-6...... 3248 Maquoketa...... Sacred Heart School...... K-12...... 3250 Marion...... St. Joseph School...... K-8...... 3271 Marshalltown...... Marshalltown Area Catholic School...... K-6...... 3474 Mason City...... Newman Catholic System...... K-12...... 1298 Monticello...... Sacred Heart School...... K-6...... 3251 New Hampton...... St. Joseph School...... K-8...... 3475 New Vienna...... Hennessy School...... K-6...... 3252 Oelwein...... Sacred Heart School...... K-6...... 3273 Osage...... Sacred Heart School...... K-6...... 3476 Ossian...... St. Francis DeSales School...... K-8...... 3274 Protivin...... Trinity Catholic School...... K-6...... 3275 Waterloo...... Waterloo Cedar Valley School System...... K-12...... 1086 Waukon...... St. Patrick School...... K-6...... 3276 Waverly...... St. Paul School...... K-6...... 3478 Webster City...... St. Thomas Aquinas School...... K-6...... 3277 Worthington...... St. Paul School...... K-6...... 3278 List School Code in Section C

7 Avoiding the Most Common Errors THE MOST COMMON ERROR THAT APPLICANTS MAKE IS SENDING THE APPLICATION INCOMPLETE. IN ORDER FOR AN APPLICATION TO BE REVIEWED, IT MUST INCLUDE: • All pages of your 2011 IRS Form 1040, 1040A, or 1040EZ (Federal Income Tax Return). Do not send your state tax return, recap, or tax summary. (If you have not yet filed your2011 IRS Form 1040, or you do not file, please see the Required Documentation Section of the instructions.)

• 2011 W-2 and/or 1099 Forms for individual(s) listed in Sections A and B (Please make sure all documentation is copied on regular 81/2 x 11 paper). • Non-taxable income verification. • A check or money order for the non-refundable application fee of $22.00. All returned checks will be subject to an additional $25.00 fee. P Print clearly and neatly with a blue or black ball point pen. P Make a photocopy of your completed Student Aid Form and all supporting documentation for your records. P Do not staple anything to the Student Aid Form. P Submit the original application only. P Affix proper postage to the envelope (applications without sufficient postage will be returned by the post office). P If you would like to receive notification that PRIVATE SCHOOL AID SERVICE has received your application, enclose a self-addressed stamped postcard or envelope with your application. P Do not send any original documents. Originals cannot be returned. PSAS CANNOT PROCESS YOUR APPLICATION IF YOU HAVE NOT INCLUDED THE REQUIRED DOCUMENTATION AND APPLICATION FEE. Other Common Errors A & B Parent, Guardian, or Other Adult H Housing Information List the parent, guardian or other adult responsible for tuition and any If you rent your home, list your monthly rental payment, including any other adult residing in the household. Complete each section in its payments made by sources other than the household. If you own your entirety, including age, social security number, and name of employer. home, answer Items 22a, b, c, and d. If you are self-employed, check the box and refer to Section K. I Assets and Investments Student Information C Enter the totals for Items 23, 24, and 25 based on your investment, List all dependent children, including college students, in order of oldest savings, and/or checking statements. If you own rental or investment to youngest. If any dependents will attend a tuition charging school next property, answer Items 26a and 26b. You must include Schedule E from fall, fill in all columns for those children. your IRS Form 1040.

Household Information If you answered “Yes” to Items 27 or 28 and are estimating 2011 income, D complete Section K of the application. You must include Schedule C, E This section should include the total number of parents, children and and/or Schedule F from your IRS Form 1040. other individuals residing in the household. Any household member listed as “Other” should be identified, using Section L if necessary for J Unusual Circumstances explanation. Check any and all items that apply to your situation. If your circumstances require explanation beyond the scope of this application, Single, Divorced, Remarried, or Separated Parents E please notify the school to which you are applying and also include a This section should be completed by the custodial parent with information letter of explanation with this application. about the non-custodial parent. K Business Income (if estimating 2011 income) F Taxable Income Answer each question that pertains to your estimated income. Answer Items 1–9b for BOTH 2011 and 2012. YOU MUST include Explanation documentation of all income received by both parents/guardians L residing with the applicant(s). If you are divorced or separated and If you feel that any specific question requires clarification and/or an receive child support, list the yearly amount in Section G, Item 10. explanation, write a brief summary in the space provided.

Certification, Authorization, and G Non-Taxable Income M Documentation Requirements List the YEARLY amounts received for Items 10-19. Remember, do not Confirm that you have attached ALL REQUIRED DOCUMENTATION list monthly amounts. and that you have signed the application. The Archdiocese of Dubuque Catholic Schools Annual Progress Report 2011 - 2012

Message from the Archbishop

Dear Friends and Supporters of We can all take great pride in the academic success of our Catholic Schools, Catholic school students. These students demonstrate to us that a strong partnership with parents/guardians, administra- In this 175th anniversary year tors, teachers and with the students themselves, lead to great Archdiocesan of the Archdiocese, and espe- success. When these partnerships are coupled with high ex- cially during Catholic Schools pectations and a solid work ethic for every child, God’s gifts in Mission Statement Week, it is good to remember these students can come to full fruition. Vision 2000 that among the first actions of The service component of a Catholic school education thrives the soon to be created Dubuque We the Church of the Archdiocese of in our Archdiocesan schools. Students, staff, and administra- Diocese in 1836, was the estab- Dubuque, are God’s people tors give back much to their local communities and parishes. lishment of its first school – St. Raphael Cathedral School. Fol- gathering together as a Eucharistic These students’ efforts to help the disadvantaged, shut-ins, lowing the opening of St. Raphael School, which started as an community to worship, sharing the those affected by disasters, and so many other unfortunate all boys’ school, Bishop Loras worked with the Sisters of Char- Word of God, affirming traditional events should serve as an example to all of us. This desire to ity of the Blessed Virgin Mary to open an all girls’ school in and emerging leadership roles and serve is inspired and cultivated every day in the Catholic school 1843, in Dubuque. Building on their success, Catholic schools supporting families to model environment. became an integral component for the spiritual formation of Catholic faith and morality for the Catholic youth in the Archdiocese. Countless religious sisters, next generation. brothers, priests, and laymen and women have worked dili- The Catholic school’s commitment to faith, academics, and ser- vice does not come without great sacrifice and commitment gently to provide the best possible Catholic school education We commit ourselves to lifelong to hundreds of thousands of youth these past 175 years. from parishioners, parents, and staff. On behalf of all who have benefited from their Catholic school education and for all who faith formation and to the service of humanity because we believe in the As we celebrate Catholic Schools Week, it is important to re- continue to reap the rewards of a Catholic school education, I Risen Christ, in the wisdom and member that these Catholic schools exist for and are dedicat- say thank you. The 175 years of Catholic school success in this kindness of God, the author of life, ed to the faith development of Archdiocesan youth. Faith is Archdiocese would not be possible without your spirit of sacri- and in the love the Holy Spirit the foundation upon which the schools have been built and fice and commitment. You remain in my prayers. faith continues to be the foundation for their success. It is in bestows. this faith-filled environment where prayer is welcome, Mass is Sincerely in Christ, celebrated, reconciliation occurs and spirituality is emphasized Most Rev. Jerome Hanus, O.S.B. Mission Statement of the that our youth come to fully understand what it means to be Archbishop of Dubuque Christian and what it means to be Catholic. Educational Apostolate Archdiocese of Dubuque

The mission of the Educational Apos- Message from the Superintendent tolate of the Archdiocese of Dubuque This year’s theme for Catholic College success, as measured by college graduation rates of is to promote lifelong faith formation Schools Week is “Faith. Academ- Archdiocesan high school alums, also reflects the quality of which challenges ics. Service.” This statement fully academic instruction, rigor, and accountability. Our Archdioce- individuals to: encapsulates the mission of our san schools are most proud of the success students from fami- • respond to God’s continuous call to Archdiocesan Catholic Schools. lies with low socioeconomic backgrounds have in our schools. conversion to Jesus Christ These schools are led by out- No matter the families’ situation, Archdiocesan schools help • form and be formed in Christian standing educators and parish all students achieve their fullest academic potential. community life leaders who ensure that the stu- dents are challenged each and Service is the “icing on the cake”. Students in Archdiocesan • grow in knowledge of faith schools contribute countless hours of service to each other, every day to grow in spirit, mind • participate in liturgical celebrations and body. to parishioners, to their local community, and throughout the in prayer world. These students, under the direction of highly-trained Faith is the cornerstone upon which Catholic Schools build. staff, do so much to give to others. Service activities range • collaborate in the Church’s mission of evangelization Our Catholic schools “are a vital part of the teaching mission from raking leaves in the fall and spring, visiting shut-ins to of the Catholic Church” according to the United States Catholic spending weeks at places like Catholic Heart Work Camps and Conference of Bishops. The most important “subject” taught Haiti. These examples are just a small fraction of all that our in a Catholic School is spiritual formation of all – the students, students accomplish to breathe life into their faith. staff, board, and parents. Spiritual formation is crucial in the development of the total person in a Catholic school envi- None of this is possible without the generosity of so many ronment. Spirituality and values are taught on the Catholic priests, parishioners, board members, faculty and administra- Church’s terms, not the secular world’s view. tors. It is important to stop during Catholic Schools Week to not only celebrate with our Catholic schools, but to give thanks Academics in Archdiocesan Catholic Schools are outstanding to those who work to make each one possible and successful. by any measure. Students at all grade levels achieve at an ex- tremely high level in the Iowa Assessments (ITBS/ITED tests), God Bless, the federally- established proficiency rates, and on ACT tests. Jeff Henderson, Ed.S. Superintendent of Schools Archdiocesan Proficiency Levels Proficiency is the percentage of all students in intermediate and high achievement levels At a Glance 4th Grade Year Math Reading Science In Iowa 81.3% of the 4th graders Schools / Enrollment: 08/09 88.6% 88.2% are proficient in math; 81.6% in • There are 44 elementary / middle schools and seven 09/10 86.8% 85.2% secondary schools in the Archdiocese of Dubuque. 10/11 89.5% 88.2% 88.3% reading, 82.5% in science. • Early childhood enrollment is 2,863, including infant care, daycare, and preschool. (There are 42 Early Child- 8th Grade hood Centers in the Archdiocese of Dubuque, ranging from infant care to preschool programs.) Year Math Reading Science In Iowa 76.5% of the 8th graders 08/09 87.5% 85.5% 90.7% • Kindergarten through eighth grade enrollment is 9489. are proficient in math; 74.4% in • High School (grades 9-12) enrollment is 2,329. 09/10 88.8% 82.8% 87.6% • The student population is 9.1% ethnically diverse. 10/11 89.4% 87.5% 91.9% reading; 83.5% in science. • 15.4% of the student population qualifies for free or reduced lunch under the Federal Nutrition Program. 11th Grade Year Math Reading Science In Iowa 76.4% of the 11th graders Staffing: 08/09 89.2% 87.6% 89.9% are proficient in math; 76.8% in • There are 816 full-time certified staff and 198 part-time 09/10 88.2% 89.6% 87.3% 10/11 88.8% 85.1% 88.3% reading; 81.3% in science. certified staff. • Lay personnel comprise 98.8% of the faculty and the remaining 1.2% are sisters or priests. Dropout Rate – Grades 7-12: • There was a .04% dropout rate in the 2010-11 school year. This compares favorably to the Iowa rate of 3.15% in 2010-11. Post-Secondary Education: • At least 97.3% of the graduating seniors pursued post secondary education / training following graduation in May of 2011, as self reported by the seven high schools. This compares favorably to a rate of 81.2% in Iowa public schools, according to the Annual Condition of Education Report, 2010. Revenue Percentages for Catholic Schools High School Graduation Rate: • The graduation rate was 99.8% in May 2011 in the seven Archdiocesan High Schools. This compares favor- ably to a rate of 88.7% in Iowa public schools, according to the Annual Condition of the Education Report, 2009.

Sources: Archdiocesan Status Reports, 2011-12 The Annual Condition of Education Report, 2011 N.C.E.A. Report, 2011 Annual Progress Report Data, 2010-11. Elementary/Middle School Averages Secondary Averages Expense Percentages for Catholic Schools

* Data is composite of averages for previous three years

Elementary/Middle School Averages Secondary Averages Elementary (K-8): $49,204,462 Secondary (9-12): $22,753,842 Total Expenditures for Catholic Schools: $71,958,304 The PTO cordially invites your family to celebrate Catholic School Week. This is a great way to get to know parents, students and teachers. Please join us!

When: February 4, 2012 Where: Anamosa Bowling Alley Time: 2:00-4:00 pm Cost: $2.50 per game (no shoe rental)