2011 - SALT LAKE LUTHERAN HIGH SCHOOL - 2012

ADMISSIONS CHECKLIST
Carefully read the following Application for Admission Instructions. Acceptance cannot be considered until all items
listed below are received in the Lutheran High School office. Final decision of acceptance rests with the Principal. You will
be notified by mail upon your acceptance to Lutheran High School.

Application Fee = $250 ($150 non-refundable) and 10% Tuition Deposit ($860/$760) (See Early Registration Discount)
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(*Early Registration Discount = $100 less if paid by March 31 . The Tuition Deposit is non-refundable after August enrollment.)

à ENROLLING IN GRADE 9
q 1. Complete and submit the LHS Application for Admission.
q 2. Forward the LHS Association Member Status form to your pastor (if applicable) (yellow sheet).
q 3. Complete and submit the LHS Covenant Agreement (blue sheet).
q 4. Complete and submit the LHS Parent Support Form (pink sheet).
q 5. Have a current teacher complete and submit the LHS Teacher Recommendation Form (orange sheet).
q 6. Submit Immunization Forms.
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q 7. Complete and submit the results of the 8 grade Standardized Test (SAT, IOWA, etc).
q 8. Complete and submit the Financial Agreement Form (green sheet).
o (also Smart Tuition Enrollment Form if paying tuition monthly)
q 9. Submit the Application Fee ($150 Non-refundable) & Tuition Deposit (Non-refundable after August enrollment).
q 10. Complete a Personal Interview with the Principal and/or Counselor (required - if not waived).

à TRANSFERRING TO LHS
q 1. Complete and submit the LHS Application for Admission.
q 2. Forward the LHS Association Member Status form to your pastor (if applicable) (yellow sheet).
q 3. Complete and submit the LHS Covenant Agreement (blue sheet).
q 4. Complete and submit the LHS Parent Support Form (pink sheet).
q 5. Have a current teacher complete and submit the LHS Teacher Recommendation Form (orange sheet).
q 6. Submit Immunization Forms.
q 7. Submit Transcripts from former school(s).
q 8. Complete and submit the Financial Agreement Form (green sheet).
o (also Smart Tuition Enrollment Form if paying tuition monthly)
q 9. Submit the Application Fee ($150 Non-refundable) & Tuition Deposit (Non-refundable after August enrollment).
q 10. Complete a Personal Interview with the Principal and/or Counselor (required).

à RE-ENROLLING @ LHS
q 1. Complete and submit the LHS Application for Re-Enrollment.
q 2. Forward the LHS Association Member Status form to your pastor (if applicable) (yellow sheet).
q 3. Complete and submit the LHS Covenant Agreement (blue sheet).
q 4. Complete and submit the LHS Parent Support Form (pink sheet).
q 5. Complete and submit the Financial Agreement Form (green sheet).
o (also Smart Tuition Enrollment Form if paying tuition monthly)
q 6. Submit the Application Fee ($150 Non-refundable) & Tuition Deposit (Non-refundable after August enrollment).

Please follow these directions carefully so your application may be processed without delay.
THANK YOU!
For assistance please call the School Office at (801) 266-6676.
 APPLICATION FOR ADMISSION
2011-12
LUTHERAN HIGH SCHOOL
4020 South 900 East
Salt Lake City, Utah 84124-1169
(801) 266-6676

Applying for (please circle one): Grade 9 10 11 12 Date:

The purpose of this application is to gain information about the student who is applying for admission to Lutheran
High School and his/her parents or guardians. This information will be used in conjunction with other data as part of
the admission decision process. The contents of this application, and all other submitted information, will be
considered confidential.

The following fees must accompany this application:

Application Fee = $250 ($150 Non-refundable)(applied to General Fee upon acceptance)
Tuition Deposit = $860 Non-Assoc./$760 Assoc. (Non-refundable after August enrollment. See below.)
(Early Registration Discount = $100 off Tuition Deposit if applying before March 31.)

THE APPLICATION FEE AND TUITION DEPOSIT MUST ACCOMPANY YOUR APPLICATION.

Student’s Name:
Last First Middle

Home Address:
Street

Best Telephone: ( )
City State Zip

Student’s Social Security #______- ______-______ Sex: Male ___ Female ___ Shirt Size:
(must have this)

Date of Birth: Country of Citizenship:

Place of Birth: EMAIL:

City State/Country

Church Affiliation:
Congregation Denomination Pastor

Date of Baptism: (if applicable) Date of Confirmation: (if applicable)

Student is a graduate from: Christ __ Grace __ Redeemer __ St. Paul (Ogden) __ What year?

School Most Recently Attended:

School Address:
Street City State Zip
 FAMILY INFORMATION (If identical – please reference “Same”)

Father/Male Guardian Mother/Female Guardian

Name: Name:
*Mr. *Dr. *Other *Mrs. *Ms. *Dr. *Other
Soc Sec # - - Soc Sec # - -
(must have this) (must have this)
Home Address: Home Address:

City State Zip City State Zip

Home Phone: Home Phone:

Cell Phone: Cell Phone:
Highest level of Education Completed: Highest Level of Education Completed:

Occupation: Occupation:
Employer: Employer:
Job Description/Title: Job Description/Title:

Business Address: Business Address:

Street Street

_
City State Zip City State Zip

Business Phone: Business Phone:

EMAIL: EMAIL:
Names and ages of siblings and school(s) currently attending: _

Applicant’s natural parents are: *Married *Divorced *Separated *Father Deceased *Mother Deceased
Name of Stepfather: Name of Stepmother:
Grandparents (Dad’s side) :
Address:
City: State: ___________ Zip:
Phone: (BEST) EMAIL:
Church Membership: Pastor:

Grandparents (Mom’s side) :

Address:
City: State: ___________ Zip:
Phone: (BEST) EMAIL:
Church Membership: Pastor:
Please explain any special or unusual family circumstances.
 ACADEMIC INFORMATION

Please explain any special talents or achievements the applicant has attained, either in or outside of school.

Describe briefly the applicant’s present school experience. Please include information about the applicant’s
academic abilities, achievements, motivations and social development.

Has the applicant ever skipped or repeated a grade? If yes, please indicate the grade and the
circumstances.

Why is your child leaving his/her school? (Graduation, recently moved, other…)

Has the applicant ever been diagnosed with a learning disability? If yes, please submit the diagnosis.

Did the applicant follow an I.E.P. or 504 at a previous school? If yes, please submit the plan.

Has the applicant ever received any other educational, psychological or intellectual testing beyond the normal
school administered achievement batteries? If yes, please explain and submit results

Describe any other special circumstances which have affected the applicant’s performance in school. (Examples
might include tutoring, physical challenges, emotional trauma, talented and gifted programs…)
 MEDICAL INFORMATION

Does the applicant have any health condition, physical/emotional, which warrants special consideration or
would restrict involvement in school programs including physical education or participation on a sports team?
If yes, please explain.

Is the applicant taking any daily medication? (i.e. to treat ADD, ADHD, allergies, diabetes…)
If yes, please list them - noting those that are taken during the school day. (Also, please update us if they change.)

The State of Utah requires parent/guardian permission before we can dispense Tylenol/Ibuprofen to your student: I
give permission for the staff of Lutheran High School to give my student ______ tablets/day of
Tylenol/Ibuprofen anytime during this school year.
(Parent/Guardian Signature)

School Student Likeness/Photo Agreement: I grant permission for my student or likeness to be included in any
media that the school may use for school newsletters, yearbook, promotions, school website, etc.

(Parent/Guardian Signature)

School Directory Agreement: I grant permission for my child’s name, address, and phone number to be
included in a family directory, which may be distributed to each enrolled school family. (This information may also be

used for emergency telephone trees.)

(Parent/Guardian Signature)

PERSONAL INFORMATION

Why do you want your child to attend Lutheran High School?

Why do you feel Lutheran High School will be a good match for your child?

What do you feel is the most important aspect of your child’s high school education?
 REFERENCES

Please list the names of two people who know the applicant and his/her family. One name should be a current
teacher; the other may be a friend of the family, business associate, or other Lutheran High family member.

Name:
Address:
Street City State Zip

Home Telephone: Business Telephone:

Relationship to Applicant:

Name:
Address:
Street City State Zip

Home Telephone: Business Telephone:

Relationship to Applicant:

TUITION AGREEMENT (All Information Required)

Person responsible for tuition and fees:

Name:
Relationship to Student

Billing Address:
Street City State Zip

Phone: (BEST) EMAIL:

Do you intend to apply for financial assistance? Yes No If yes, financial aid materials are enclosed.

FORMAL APPLICATION STATEMENT

I hereby make formal application for my son/daughter to attend Lutheran High School for the 2011-12 School Year.
I certify that the information given herein for the purpose of obtaining admission to Lutheran High School is correct
and true to the best of my knowledge. I agree to legally bind myself to pay all tuition, assessments, and late fees in
full in accordance with the terms elected at the time of enrollment. I understand that all tuition and fees must be
paid in full before transcripts, report cards, diplomas, or transfers may be issued. I also understand, should
transfer become necessary during the school year, that all fees, other than tuition, are non-refundable and that
tuition will be refunded as per the financial agreement (unless the transfer is a result of disciplinary action – i.e.
expulsion). I further understand that my student may not re-enroll at Lutheran High School until our account is
current from this year. I also understand that current acceptance for admission to Lutheran High School should not
be construed as automatic re-admission for subsequent years.

I am enclosing a $250 Application Fee ($150 Non-refundable) and 10% Tuition Deposit ($860/$760).
(Tuition Deposit is Non-refundable after August enrollment.)

Signature of parent/guardian Date

 APPLICANT QUESTIONNAIRE

To the Applicant: Please respond to the following questions in complete sentences in your own words. Try
to express your thoughts as clearly and specifically as possible. Your answers will help the Admissions
Committee to process your application. PLEASE PRINT.

Your Name: Date:

Candidate for grade (circle one) 9 10 11 12 for the 2011-12 school year.

What academic subjects of study do you enjoy the most? Why?

Are there any subjects that you don’t particularly enjoy? Which one(s) and why?

How would you rate your study habits? (circle a number)

1- poor 2 - fair 3 - good 4 - very good 5 - excellent

How would you describe yourself as a student?

How would you describe yourself as a friend?

How do you like to spend your free time outside of school?

Please describe your experience or interest in the fine arts.

Do you play a musical instrument? If so, which one(s) and for how long?

Have you received any scholastic, athletic or community honors or awards? If so, please describe.

Is there anything else you would like us to know about you?

ATHLETIC INFORMATION

List your Interest (I) or Experience (E) in the following athletic activities.

___ Boys Baseball (Fall)
___ Girls Volleyball (Fall)
___ Cross Country (Fall)
___ Other
___ Other
___ Boys Basketball (Winter) ___ Golf (Spring)
___ Girls Basketball (Winter) ___ Boys Soccer (Spring)
___ Swimming (Winter) ___ Girls Soccer (Spring)
___ Track (Spring)

For those items listed as Experienced please answer the following:

1. Did you participate (practice or tryout) in this activity at the high school level under the supervision of a State
High School Association? ____Yes ____No (If ‘Yes” go to #2)

2. At which high school did you participate?

Name: City: State:

3. In which activities did you participate?

4. In what level did you participate?

____Freshman/Sophomore team ___Junior Varsity ____Varsity
 NARRATIVE TO APPLICATION

Please indicate why you wish to attend Lutheran High School and how you think you can make a positive
contribution to the school community. Some areas you should address are your personal educational
philosophy and your impressions of Lutheran High School. If you need additional space, you may attach a
separate sheet of paper.

Non-Discrimination Policy
Lutheran High School admits students of any race, color, national or ethnic origin
to all rights, privileges, programs, and activities generally accorded or made available to students at the school.
Lutheran High does not discriminate in the administration of its educational policies, admissions policies, scholarship,
and athletic or other school-administered programs.
 ASSOCIATION GRANT APPLICATION 2011-12
LUTHERAN HIGH SCHOOL
4020 South 900 East
Salt Lake City, UT 84124
Phone: (801) 266-6676 - Fax: (801) 266-1953
Email: principal@lhs-slc.org

Student Name (Please print) Grade

Parent Name(s) (Please print) Best Phone

(Current Association Congregations: Christ Lutheran - Murray, Cross of Christ Lutheran - Bountiful, First Lutheran -Tooele,
Grace Lutheran - Sandy, Redeemer Lutheran - SLC, and St. John’s Lutheran - SLC)

Please list specific ways that you (and the members of your family) are active and participating in the
life of your congregation. These can include things like church attendance, active in youth group,
teaching Sunday school, singing in the choir, helping with projects or work days, ushering, serving on a
board or committee, etc.

VERIFICATION OF ASSOCIATION MEMBER STATUS

Lutheran High is supported by its association congregations with prayers, volunteers, students, staff,
and gifts. Students who are members of our association congregations are eligible to receive a financial
discount; therefore it is necessary that we have a written verification of member status by the pastor.

Without this verification, the association student discount cannot be given.

I, , as the Pastor of ,
(Name of Pastor) (Name of Church)

verify that _ is an active and participating,

(Name of Student)
communicant member of our congregation and should be accorded Association Member Status.

(Pastor’s Signature) (Date)

Notes:

You may detach this sheet and have your pastor mail/fax it directly to Lutheran High
 LUTHERAN HIGH SCHOOL

COVENANT AGREEMENT
Lutheran High School is a Christian community with all its strengths and weaknesses. Growing and maturing
together in God’s grace is the privilege of the student body and faculty alike. Lutheran High School wants its
students to place Jesus Christ in the very center of their lives and to learn the joy that comes from doing so.
Lutheran High School desires that its students develop a value system based on God’s divine Law and Gospel.

Students enrolled at Lutheran High School have a God-given responsibility to become the best students
possible and to develop the talents God has given. Good students will give serious effort to preparing class
assignments, participating in class discussions, improving work and study habits, and will be governed in
matters of discipline by Matthew 18. All Lutheran High School students are expected to pursue a personal
relationship with Jesus Christ as their Lord and Savior and to understand that Jesus forgives sins and wants
them to become His disciples. Students will do this through the study of God’s Word and through participation
in worship and spiritual growth experiences.

Understanding all of these things, I promise, with God’s help:

- to gladly hear and learn God’s Word, not only in the classroom but also during worship experiences.
- to honor, obey, respect, esteem, and pray for those in authority.
- to protect and respect my property, body, and reputation as well as that of other students, teachers,
and the school - not only during the school day, but at all times in my life.
- to be an example of purity in my thoughts, words, and actions.
- to support school policies.
- to be responsible for prompt and regular attendance.

From this Covenant relationship I expect to receive:

- the dignity and respect due to a child of God.
- Christian concern for my physical, intellectual, emotional, and most importantly, spiritual well-being
from all members of the school family.
- fair treatment under the rules of the school.

By signing this Covenant Agreement, I am accepting these principles as my own.

Student signature Date

By signing this Covenant Agreement, I am pledging my support for the principles stated above.

Parent/Guardian signature Date

By signing the Covenant Agreement, I am affirming the school’s responsibility in implementing

the principles stated above.
Charles Gebhardt Feb. 2011
Principal signature Date
 LUTHERAN HIGH SCHOOL
PARENT SUPPORT
(20 hours/year per family – Note: 2 hours required for help with the dinner/auction)
(Unfulfilled hours are charged at a rate of $10/hour - $25/hour for dinner/auction)

Student Name (Please print) Grade

Parent Name(s) (Please print) Best Phone Alternate Phone

Please check at least two. We’re hoping for a 100% return!

WHAT A GREAT INVESTMENT!!

Calling Parents:
_____ Be part of a calling chain for your student’s class:
- to notify students in case of weather or school emergency
- to remind parents and students of school events

Sports Parents: girls’ volleyball, boys’ baseball, cross-country, basketball, track, golf, soccer
_____ Help with concessions a few times a year
_____ Give rides to competitions
_____ Run scoreboard or keep scorebook for ____________________________
(sport - see above)

Fundraiser Parents: Help with:

_____ Golf Tournament (September)
__X__ Dinner/Auction (March) –(biggest fundraiser of them all!)(Note: 2 hours required)
_____ Mailings throughout the year
_____ Yard Sales

Activity Parents:
_____ Help with School Pride Work Days (no skill needed – a few times a year)
_____ Organize and help with School Spirit activities
_____ Attend Parent Group Meetings (usually the 2nd Monday of the month at 6:45 p.m.)
_____ Volunteer as a Library Aide
_____ Library Supervisor before/after School
_____ Coordinate Teacher Appreciation Event
_____ Awards Night (May)
_____ Graduation (June)

Music/Drama Parents:
_____ Drive to Music Events
_____ Assist with Music and Drama Productions/Performances

On-Call Parents:
_____ Help school in whatever capacity needed
_____ Special talent for school - I can
LUTHERAN HIGH SCHOOL OFFICE USE:

4020 S. 900 E. SALT LAKE CITY, UT 84124 (801) 266-6676

TEACHER RECOMMENDATION FORM

STUDENT: CURRENT SCHOOL:
APPLYING FOR: q 9th GRADE q TRANSFER FOR GRADE 10 11 12
Under the Family Education Rights and Privacy Act of 1974, which gives students (parents of minors) the right to inspect and review their education records, students (parents of minors) may
waive the right to see specific confidential statements and letters of recommendation. In the belief that applicants, and the persons from whom they request evaluations, may wish to preserve
the confidentiality of those evaluations, we are giving you the opportunity to sign the following statements. (initial one)
q I waive my right to examine this document. q I do not waive my right to examine this document.
Student (Parent if minor) Signature

THE ABOVE NAMED STUDENT IS APPLYING FOR ADMISSION TO LUTHERAN HIGH SCHOOL. YOUR COMPLETION OF THIS FORM IS A GREAT HELP TO US IN EVALUATING
QUALITIES THAT TESTS AND GRADES DO NOT EXPLAIN. ALL INFORMATION WILL BE USED FOR ADMISSION PURPOSES ONLY AND WILL BE KEPT CONFIDENTIAL.

TEACHER: POSITION:

How long have you known the applicant? years. What three words would you choose to describe this student? 1.

PLEASE CHECK THE APPROPRIATE BOX FOR EACH ITEM BELOW. 2. 3.

ACADEMIC EVALUATION
1. Overall Academic Achievement q Outstanding q Good q Satisfactory q Needs Improvement q Not Observed
2. Language Arts / Reading Ability q Outstanding q Good q Satisfactory q Needs Improvement q Not Observed
3. Language Arts / Writing Ability q Outstanding q Good q Satisfactory q Needs Improvement q Not Observed
4. Mathematic Ability q Outstanding q Good q Satisfactory q Needs Improvement q Not Observed
5. Ability/Willingness to Follow Directions q Outstanding q Good q Satisfactory q Needs Improvement q Not Observed
6. Attention Span/Ability to Focus q Outstanding q Good q Satisfactory q Needs Improvement q Not Observed
7. Willingness to Ask for Help When Needed q Outstanding q Good q Satisfactory q Needs Improvement q Not Observed
8. Handwriting/Penmanship q Outstanding q Good q Satisfactory q Needs Improvement q Not Observed
9. Ability to Work With Others (In a Group) q Outstanding q Good q Satisfactory q Needs Improvement q Not Observed
10. Study Skills/Habits q Outstanding q Good q Satisfactory q Needs Improvement q Not Observed
PERSONAL EVALUATION
11. Overall Character q Outstanding q Good q Satisfactory q Needs Improvement q Not Observed
12. Conduct/Behavior q Outstanding q Good q Satisfactory q Needs Improvement q Not Observed
13. Maturity q Outstanding q Good q Satisfactory q Needs Improvement q Not Observed
14. Organization q Outstanding q Good q Satisfactory q Needs Improvement q Not Observed
15. Integrity/Honesty q Outstanding q Good q Satisfactory q Needs Improvement q Not Observed
16. Leadership/Self-Confidence q Outstanding q Good q Satisfactory q Needs Improvement q Not Observed
17. Emotional Stability q Outstanding q Good q Satisfactory q Needs Improvement q Not Observed
18. Concern for Others/Sensitivity q Outstanding q Good q Satisfactory q Needs Improvement q Not Observed
19. Relationships with Peers q Outstanding q Good q Satisfactory q Needs Improvement q Not Observed
20. Relationships with Adults q Outstanding q Good q Satisfactory q Needs Improvement q Not Observed
TOTAL STUDENTS IN THIS CLASS: OVERALL, ACADEMICALLY AND PERSONALLY, THIS STUDENT RANKS: q FIRST q TOP 5 q TOP ¼ q TOP ½
PARENT/FAMILY EVALUATION
21. Support for Faculty and Administration q Outstanding q Good q Satisfactory q Needs Improvement q Not Observed
22. Communication with School q Outstanding q Good q Satisfactory q Needs Improvement q Not Observed
23. Involved and Helpful with School Activities q Outstanding q Good q Satisfactory q Needs Improvement q Not Observed
24. Positive Ambassadors for Your School q Outstanding q Good q Satisfactory q Needs Improvement q Not Observed
25. Would you re-admit or re-enroll this student at your school if given the opportunity again? q Yes q No q Maybe

COMMENTS ON ANY OF THE ABOVE: (Feel free to use the reverse or separate paper.)

OVERALL TEACHER RECOMMENDATION

q I HIGHLY RECOMMEND…………………………………. THIS STUDENT FOR ACCEPTANCE TO LUTHERAN HIGH SCHOOL.
q I RECOMMEND…………………………………………… THIS STUDENT FOR ACCEPTANCE TO LUTHERAN HIGH SCHOOL.
q I RECOMMEND WITH RESERVATION………………… THIS STUDENT FOR ACCEPTANCE TO LUTHERAN HIGH SCHOOL.
q I DO NOT RECOMMEND………………………………… THIS STUDENT FOR ACCEPTANCE TO LUTHERAN HIGH SCHOOL.
If we have additional questions, may we call you? q YES q NO

SIGNATURE: ________________________________________________________ DATE: ___________________ PHONE #: _________________________

THANK YOU FOR TAKING THE TIME TO COMPLETE THIS FORM AND FOR HELPING LUTHERAN HIGH SCHOOL TO BECOME BETTER AQUAINTED WITH THIS STUDENT.
Please return this form to: Lutheran High School 4020 S. 900 E. Salt Lake City, UT 84124 or FAX to: 801/266-1953
 SALT LAKE LUTHERAN HIGH SCHOOLOFFICE USE:
4020 SOUTH 900 EAST SALT LAKE CITY, UT 84124 (801) 266-6676

FINANCIAL AGREEMENT FORM 2011-2012

NAME & ADDRESS OF PERSON(S) RESPONSIBLE FOR PAYMENT:

NAME SOCIAL SECURITY #

ADDRESS CITY ZIP CODE

PHONE: BEST ( ) EMAIL

LIST OTHER CHILDREN ENROLLED AT SALT LAKE LUTHERAN HIGH SCHOOL. REDUCED RATES APPLY FOR STUDENTS ENROLLED FROM THE SAME FAMILY.

NAME GRADE q NEW q RETURNING q ASSOCIATION

NAME GRADE q NEW q RETURNING q ASSOCIATION

TUITION AND FEE INFORMATION $7,600.00 USD TUITION $8,600.00 USD

ASSOCIATION . NON-ASSOCIATION .

1. APPLICATION FEE: Credited to General Fee (below) if accepted q $250.00 PAID (Required w/ Application) q $250.00 PAID (Required w/ App.)
$150 NON-REFUNDABLE $150 NON-REFUNDABLE

2. 10% TUITION DEPOSIT q $760.00 PAID (Required w/ Application) q $860.00 PAID (Required w/ App.)
(NON-REFUNDABLE AFTER AUGUST ENROLLMENT)
(Early Registration Discount before March 31st - $100 LESS) q $660.00 PAID q $760.00 PAID
EACH ADDITIONAL STUDENT q $680.00 PAID q $780.00 PAID
(Early Registration Discount before March 31st - $100 LESS) q $580.00 PAID q $680.00 PAID
3. TUITION (Select one plan)
q ANNUAL PLAN Full payment of yearly tuition is payable on or before August 1, and receives a $250 discount .
Less 10% Deposit q $6,590.00 ($6,840.00 - $250) q $7,490.00 ($7,740.00 - $250)
EACH ADDITIONAL STUDENT q $5,870.00 ($6,120.00 - $250) q $6,770.00 ($7,020.00 - $250)
q SEMESTER PLAN Tuition is paid twice a year. The two payments are due on August 1 and January 1.
A late fee of $50 will apply after August 15 and January 15.
Less 10% Deposit q $3,420.00 x 2 q $3,870.00 x 2
EACH ADDITIONAL STUDENT q $3,060.00 x 2 q $3,510.00 x 2

q MONTHLY PLAN Balance of Tuition is paid over a 9-month period from Sept. – May (via EFT). Participation in this plan
REQUIRES ENROLLMENT in Smart Tuition (Complete the enclosed form and return to LHS).
q $760.00 x 9 q $860.00 x 9
EACH ADDITIONAL STUDENT q $680.00 x 9 q $780.00 x 9
4. ADDITIONAL FEES q General Fee $400.00 (books, yearbook, consumables, fine arts, PE…) $250 Application Fee applies
q Sports Fee $100.00 for each sport played: x =
q Distance Learning Classes $350.00/semester, plus books/lab fee
TUITION AND FEES POLICIES Tuition & fees for a semester are to be paid in full before the start of the next semester. Late or delinquent
payment of tuition can result in fines or dismissal from school. (See Board Policy re. Tuition, Fees…)
REFUND POLICY Enrollment of a student implies a commitment of attendance and corresponding payment of tuition for at least one
semester. $150 of the application fee is non-refundable. The 10% Tuition Deposit and additional fees are non-refundable
after August enrollment. A written statement from the parent/guardian is required to withdraw the student from the
school. Refunds for tuition (less 10% tuition deposit after enrollment) are based on the following schedule:
F prior to Sep. 1 100% refund for the 1st semester F prior to Jan. 21 100% refund for the 2nd semester
F Sep. 1 to Sep. 10 75% refund for the 1st semester F Jan. 21 to Feb. 10 75% refund for the 2nd semester
F Sep. 11 to Sep. 20 50% refund for the 1st semester F Feb. 11 to Feb. 20 50% refund for the 2nd semester
No refunds after September 20th for the 1st semester or after February 20th for the 2nd semester.

SIGNATURE OF PERSON RESPONSIBLE FOR PAYMENT OF TUITION AND FEES

I HEREBY AGREE TO PAY TUITION AND FEES ACCORDING TO THIS FINANCIAL AGREEMENT. I UNDERSTAND THE REFUND POLICY STATED ABOVE.

SIGNATURE ________________________________________________________ RELATIONSHIP ______________________________ DATE __________________________

 OTHER WAYS TO HELP LUTHERAN HIGH SCHOOL
PRAY – We invite you to remember to include Lutheran High in your regular prayers and to pray often
VOLUNTEER – Lutheran High School always has “projects” that could use your help. These range from cleaning,
painting, and repair to stuffing mailings to helping with our fundraisers like the golf tournament and dinner auction.
SERVE – We could use your particular talents to assist us on any of our school committees (contact Mr. Gebhardt or
the current board chair for more information) or serving with the Parents’ Group which meets regularly and does so
much for our wonderful students and teachers!
HELP LUTHERAN HIGH EVERY TIME YOU SHOP – Your shopping can give additional funds to LHS for our school’s
programs. Smith’s, and Office Depot support schools with donation dollars based on shoppers that use their rewards
programs. Smith’s donates to LHS everytime you use your registered Smith’s Fresh Values card (Smith’s LHS ID # is
2160) The school never receives any personal information about you or what you’ve purchased. The store simply
sends the school a percentage of all purchases that are linked to LHS. The more people signed up the more the school
receives. Office Depot simply requires that you share the school’s ID number (70102813) with them and they give LHS
5% of your purchase! That’s totally free money! For more information please call the school. Go to the customer
service counter in either of these stores for details of their programs
LHS BOOSTERS – Lutheran High continues to partner with individuals, families, and businesses in our local
congregations in our “BOOSTERS” program which is a comprehensive advertising package consisting of gym banners,
website linking, and listings in our publications. If you are interested in more information, please visit our website
www.lhs-slc.org or contact Mr. Gebhardt at the school.
SCHOLARSHIP FUND – Each year, Lutheran High awards thousands of dollars in financial aid to students who desire
to attend LHS but are unable to meet the full tuition obligations. These monies are made available through the generous
gifts of many individual donors. Please prayerfully consider making a donation to the school’s designated
Scholarship Fund to help these deserving students attend Lutheran High School.
ONLINE GIVING – Lutheran High has the ability to accept donations by credit card over the Internet. Simply visit our
website and click on the link “Donate Now” for easy directions to use this secure, easy, and quick way to make your
gift! (We accept Visa, Master Card, Discover, American Express and PayPal.)
www.goodsearch.com - We have registered Lutheran High School on this Yahoo! search-engine’s website. Just go to
www.goodsearch.com and type in Salt Lake Lutheran High School under the “I’m Supporting” banner and each
search you perform deposits one penny into our account. I know that doesn’t sound like much, but when you consider
the hundreds and thousands of searches done by our supporters and their friends over the course of a year, it quickly
adds up! Pass this information along to all your friends and relatives.

IF YOU HAVE ANY QUESTIONS ABOUT THESE OPPORTUNITIES,

PLEASE CONTACT MR. GEBHARDT
DISCOUNT “Gift-Back” DONATION – Consider your unique opportunity of “gifting” back your association or other
discount to Lutheran High in the form of a donation: Simply complete and detach the following form:

+++++ LUTHERAN HIGH SCHOOL “Gift-Back” DONATION +++

Mr. Gebhardt, we know we are entitled to the following Lutheran High discounts and we are grateful.
q $1000.00 Association Discount
q $800.00 Additional Child Discount
q $500.00 Outstanding 8th Grade Student Discount
q $100.00 Early Registration Discount
q $ Other discount or amount we’d like to “Gift-Back” for everything God has given to us!
However, the Lord has blessed us with so much and we would like to help out other students who wish to attend
Lutheran High as well, so please accept this gift of:
$ (Gifts are tax deductible to the extent provided by law.)

Name(s): _______________________________________________ Address: ___________________________________________.

City: __________________________ State: __________________ Zip: _____________________.

q Please check to see if your employer matches gifts to schools. This is an easy way to double your gift back to Lutheran High.