Richard Montgomery High School
LOCAL SUMMER MATH PREP PROGRAM – FINANCIAL AID
To be completed by PARENT/GUARDIAN. Please mail form, required documentation, and check or money order for
reduced session fee* to:
Richard Montgomery High School
250 Richard Montgomery Drive
Rockville Md 20852
You can also drop off the forms to the Financial Office between the hours of 8 a.m. and 2 p.m.
PART I: STUDENT INFORMATION
Student ID # ___________________
Current Grade: ____________
Student’s Name: ______________________________________________________________________________
Parent/Guardian’s Name: _______________________________________________________________________
Address: ____________________________________________________________________________________
Best phone number contact: ______________________
Best e-mail contact: ________________________
Part II: REGISTRATION
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Algebra 1
Honors/OnLevel Geometry
Honors/OnLevel Algebra 2
Honors/OnLevel PreCalc
Session 1 July 11 – July 15
Session 1 July 11 – July 15
Session 1 July 11 – July 15
Session 1 July 11 – July 15
☐ Algebra 1
☐ Honors/OnLevel Geometry
☐ Honors/OnLevel Algebra 2
☐ Honors/OnLevel PreCalc
Session 2 July 18 – July 22
Session 2 July 18 – July 22
Session 2 July 18 – July 22
Session 2 July 18 – July 22
*Part III: PARTIAL WAIVER of SUMMER SCHOOL TUITION *
Please attach ONE of the following:
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All W-2 forms for tax year 2015
The FIRST PAGE of the family’s tax return
Copy of a current letter from a family assistance agency
Notarized statement of income from self-employment or
other sources of income
If your income is:
*You pay:
$0 - $30,866 or copy of letter from a
family assistance agency
$35
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$30,867 - $44,123
$50
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$125
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Over $44,124 (full tuition)
Be sure to write your child's name, student ID, course, and preferred session in the memo line of the check.
Checks should be made out to RMHS.
PART IV: PARENT’S /GUARDIAN’S SIGNATURE: Parent’s/guardian’s signature certifies that:
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Student is authorized to enroll in the local summer school program
I certify that all of the above information is true and that I have attached the required verification document. I understand
that school officials may verify the information on this form.
Method of payment is assured, and it is understood that a $25.00 fee will be assessed for returned checks
____________________________________________
Signature, Parent/Guardian
____/____/____
Date