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2. Thank you for applying to our Next Generation Support Program!

   For the 2025-2026 school year, Middletown Township will be offering free tutoring services to students from income-eligible households who fell behind academically during the pandemic. 

   Tutoring will take place on Saturdays from September 27^th through May 16^th at the Middletown Township Public Library (55 New Monmouth Road). Sessions will run from 9:30 AM to 12:00 PM.

   The program will be funded through a special allocation of the Community Development Block Grant CARES Act the Township received.

   Additional Information:

   • This program is for students ranging from 4^th through 8^th grade in the 2025-2026 school year.
   • There will be Language Arts and Math lessons based on the New Jersey Student Learning Standards.
   • There will be hands-on educational activities.
   • Students will be grouped by grade level.
   • Household information pertains to the student's primary residence.
   • Students' academic levels will be assessed to determine if they are eligible.
4. Name of Parents/Guardians*
6. Street Address*
8. City/Town*
9. State*
10. Zip Code*
12. Preferred Phone Number*
13. Email Address*
17. Employment Information
19. Employer's Name*
21. Street Address*
23. City/Town*
24. State*
25. Zip Code*
27. Phone Number*
28. Annual Salary*
32. Spouse/Partner's Employer

    A spouse/partner is required to answer these questions. If you do not have a spouse/partner or if they are unemployed, kindly respond N/A.

34. Employer's Name*
36. Street Address*
38. City/Town*
39. State*
40. Zip Code*
42. Phone Number*
43. Annual Salary*
47. Household Information

    Household information pertains to the student's primary residence.

49. Total Household Salary*
50. Social Security Payment
51. Pension(s)
53. Rental Income
54. Other Income
55. Interest/Dividends
57. Disability
58. Unemployment
59. Alimony/Child Support
61. Total Gross Household Income*
62. Total Household Members*
63. Total Household Members 18+ Years of Age*
67. Student(s) Enrolling in the Tutoring Program Information
69. Student 1 Name*
71. What school is the student currently attending?*
72. What grade is the student currently in?*
74. Student 2 Name
76. What school is the student currently attending?
77. What grade is the student currently in?
79. Student 3 Name
81. What school is the student currently attending?
82. What grade is the student currently in?
84. Student 4 Name
86. What school is the student currently attending?
87. What grade is the student currently in?
93. Required Income Documentation

    The following documents need to be provided by every household member 18 years of age or older. Please upload your documents below. We kindly ask that any other household members who are 18 years of age or older and do not have room below to upload their documents to please email them to Jill Cammarosano at jcammarosano@middletownnj.org.

95. Applicant 1 Name*
96. Number of Household Members Over 18*
98. If you do not upload one or more of the required documents, please explain why.
100. Four (4) consecutive pay stubs, not more than 120 days old (including bonuses, overtime, or tips if available)

     Please combine the pay stubs into one file.

101. Letter from employer stating the present annual income figure
102. Copies of filed Federal and State income tax returns for each of the preceding three (3) tax years

     Please combine the copies into one file.

104. A letter or appropriate reporting form verifying monthly benefits such as Social Security, unemployment, welfare, disability, or pension income (monthly or annually)
105. A letter or appropriate reporting form verifying any other sources of income claimed by the applicant, such as alimony or child support
106. Recent statements from banks or other financial institutions holding or managing savings, checking, trust funds, money market accounts, certificates of deposit, stocks, or bonds

     The statements must be a complete set. Please combine the statements into one file.

108. Evidence or reports of income from directly held assets such as real estate or businesses

     Please combine the evidence or reports of income into one file.

109. Mortgage statement (including lines of credit and home equity loans) showing outstanding mortgage debt
110. 4506-T Form

112. If you have a spouse/partner who lives in your house, they are considered to be Applicant 2 and are also required to provide these documents below. If you do not have a spouse/partner who lives in your house, kindly respond N/A to their name.

114. Applicant 2 Name*
116. Four (4) consecutive pay stubs, not more than 120 days old (including bonuses, overtime, or tips if available)

     Please combine pay stubs into one file.

117. Letter from employer stating the present annual income figure
118. Copies of filed Federal and State income tax returns for each of the preceding three (3) tax years

     Please combine the copies into one file.

120. A letter or appropriate reporting form verifying monthly benefits such as Social Security, unemployment, welfare, disability, or pension income (monthly or annually)
121. A letter or appropriate reporting form verifying any other sources of income claimed by the applicant, such as alimony or child support
122. Recent statements from banks or other financial institutions holding or managing savings, checking, trust funds, money market accounts, certificates of deposit, stocks, or bonds

     The statements must be a complete set. Please combine the statements into one file.

124. Evidence or reports of income from directly held assets such as real estate or businesses

     Please combine the evidence or reports of income into one file.

     
     

125. Mortgage statement (including lines of credit and home equity loans) showing outstanding mortgage debt
126. 4506-T Form
128. If you do not upload one or more of the required documents, please explain why.
132. Required Financial Statements

     Every household member 18 years of age or older are required to complete the following financial statement questions. If these accounts do not pertain to you, kindly respond N/A. If there are any other household members who are 18 years of age or older and do not have room below to answer the required questions, please email your responses to Jill Cammarosano at jcammarosano@middletownnj.org.

134. Checking Account for Applicant #1
136. Cash Value*
137. Income from Assets*
138. Name of Financial Institution*
139. Account Number (Last 4 Digits Only)*
141. Checking Account for Applicant #2
143. Cash Value*
144. Income from Assets*
145. Name of Financial Institution*
146. Account Number (Last 4 Digits Only)*
148. Checking Account for 18+ Household Member
150. Cash Value
151. Income from Assets
152. Name of Financial Institution
153. Account Number (Last 4 Digits Only)
155. Checking Account for 18+ Household Member
157. Cash Value
158. Income from Assets
159. Name of Financial Institution
160. Account Number (Last 4 Digits Only)
164. Savings Account for Applicant #1
166. Cash Value*
167. Income from Assets*
168. Name of Financial Institution*
169. Account Number (Last 4 Digits Only)*
171. Savings Account for Applicant #2
173. Cash Value*
174. Income from Assets*
175. Name of Financial Institution*
176. Account Number (Last 4 Digits Only)*
178. Savings Account for 18+ Household Member
180. Cash Value
181. Income from Assets
182. Name of Financial Institution
183. Account Number (Last 4 Digits Only)
185. Savings Account for 18+ Household Member
187. Cash Value
188. Income from Assets
189. Name of Financial Institution
190. Account Number (Last 4 Digits Only)
194. Credit Union for Applicant #1
196. Cash Value*
197. Income from Assets*
198. Name of Financial Institution*
199. Account Number (Last 4 Digits Only)*
201. Credit Union for Applicant #2
203. Cash Value*
204. Income from Assets*
205. Name of Financial Institution*
206. Account Number (Last 4 Digits Only)*
208. Credit Union for 18+ Household Member
210. Cash Value
211. Income from Assets
212. Name of Financial Institution
213. Account Number (Last 4 Digits Only)
215. Credit Union for 18+ Household Member
217. Cash Value
218. Income from Assets
219. Name of Financial Institution
220. Account Number (Last 4 Digits Only)
224. Mutual Funds for Applicant #1
226. Cash Value*
227. Income from Assets*
228. Name of Financial Institution*
229. Account Number (Last 4 Digits Only)*
231. Mutual Funds for Applicant #2
233. Cash Value*
234. Income from Assets*
235. Name of Financial Institution*
236. Account Number (Last 4 Digits Only)*
238. Mutual Funds for 18+ Household Member
240. Cash Value
241. Income from Assets
242. Name of Financial Institution
243. Account Number (Last 4 Digits Only)
245. Mutual Funds for 18+ Household Member
247. Cash Value
248. Income from Assets
249. Name of Financial Institution
250. Account Number (Last 4 Digits Only)
254. Stocks/Bonds for Applicant #1
256. Cash Value*
257. Income from Assets*
258. Name of Financial Institution*
259. Account Number (Last 4 Digits Only)*
261. Stocks/Bonds for Applicant #2
263. Cash Value*
264. Income from Assets*
265. Name of Financial Institution*
266. Account Number (Last 4 Digits Only)*
268. Stocks/Bonds for 18+ Household Member
270. Cash Value
271. Income from Assets
272. Name of Financial Institution
273. Account Number (Last 4 Digits Only)
275. Stocks/Bonds for 18+ Household Member
277. Cash Value
278. Income from Assets
279. Name of Financial Institution
280. Account Number (Last 4 Digits Only)
284. Real Estate for Applicant #1
286. Cash Value*
287. Income from Assets*
288. Name of Financial Institution*
289. Account Number (Last 4 Digits Only)*
291. Real Estate for Applicant #2
293. Cash Value*
294. Income from Assets*
295. Name of Financial Institution*
296. Account Number (Last 4 Digits Only)*
298. Real Estate for 18+ Household Member
300. Cash Value
301. Income from Assets
302. Name of Financial Institution
303. Account Number (Last 4 Digits Only)
305. Real Estate for 18+ Household Member
307. Cash Value
308. Income from Assets
309. Name of Financial Institution
310. Account Number (Last 4 Digits Only)
314. Others Assets (IRA, 401-K) for Applicant #1
316. Cash Value*
317. Income from Assets*
318. Name of Financial Institution*
319. Account Number (Last 4 Digits Only)*
321. Other Assets (IRA, 401-K) for Applicant #2
323. Cash Value*
324. Income from Assets*
325. Name of Financial Institution*
326. Account Number (Last 4 Digits Only)*
328. Other Assets (IRA, 401-K) for 18+ Household Member
330. Cash Value
331. Income from Assets
332. Name of Financial Institution
333. Account Number (Last 4 Digits Only)
335. Other Assets (IRA, 401-K) for 18+ Household Member
337. Cash Value
338. Income from Assets
339. Name of Financial Institution
340. Account Number (Last 4 Digits Only)
Leave This Blank:


342. 1. Receive an email copy of this form.
343. Email address

     This field is not part of the form submission.

344. Submit

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