Scholarship Program Application

Scholarship Program Application

Financial, Need-Based
If you need to mail any documentation, please send to:

RodneyStreet

504 South Clayton Street

Wilmington, DE 19805

Please do not drop off any paperwork/applications to our offices at the Siegel JCC.
Contact Information
Child's Name

First NameLast Name
Age
Gender
Date of Birth

MonthDayYear
Date
School
Parent/Guardian Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Daytime Phone

Area CodePhone Number
Evening/Cell Phone

Area CodePhone Number
Email
example@example.com
Family Household Information
Household Size
Number of Working Adults
Did your child receive a RodneyStreet scholarship for the previous program year?

YesNo
Scholarship Qualifications
Please submit the following documentation as proof of income and/or benefit assistance from all working adults in the household.

If salaried: submit most recent tax returnIf paid hourly: submit last full month's pay stubsAssistance-benefit letter(s)Reward from person(s) providing monthly living expense
Proof of Income Documentation

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Assistance, Benefit, Reward Documentation

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Please explain any extenuating circumstances that support scholarship qualification:
Child's Most Recent Report Card

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Agreement and Signature:

By submitting this application, I affirm that the facts set forth in it are true and complete. I understand that if my child is awarded a RodneyStreet scholarship, any false statements, omissions, or other misrepresentations made by me on this application may result in immediate dismissal from RodneyStreet programs.
Full Name:

First NameLast Name
Signature:

Clear
Date

MonthDayYear
Date
Our Policy

A non-returnable copy of official documents regarding proof of income and/or assistance/aid must be uploaded in order for RodneyStreet staff to make a scholarship determination. If documentation is not available, please have a school administrator, case worker or other designated official email the information requested below to admin@rstta.org (please reference information is for scholarship review):
- Name of Child Receiving Aid/Assistance
- Type of Aid/Service
- Case # (if applicable)
- Name of Official Verifying Aid
- Official Title/Position
- Contact Email/Phone Number
Should be Empty: