Heartwood: Application for Scholarships

Heartwood Scholarship Application
Heartwood offers scholarships to help meet low-income families' financial needs. As a small nonprofit it is our goal to make our programs affordable for as many families as possible. The maximum scholarship considered for Heartwood Nature Programs is 50% of the program cost for a maximum of 2 days/week of Forest School, and 2 weeks of summer camp. Scholarship applications are reviewed on a first received, first reviewed basis and distributed according to the funds available.
Personal Information

Please fill out the following information to help our Family Empowerment Coordinators make fair, impartial and compassionate decisions.
Your Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*

Area CodePhone Number
How did you hear about us?
Child's 2nd parent

First NameLast Name
2nd Parent Email
example@example.com
2nd Parent Phone Number

Area CodePhone Number
2nd Parent Address if different than applicants:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Child's Name*

First NameLast Name
Date of Birth*

MonthDayYear
Program*

ThimbleberriesHuckleberriesSalmonberriesFamily ClassAfter-schoolSummer Camp
Do you have another child you would like to apply for?*

YesNo
Second Child's First Name
Date of Birth

DayMonthYear
Program

ThimbleberriesHuckleberriesBlackberriesSalmonberriesFamily ClassAfter-schoolSummer Camp
Do you have another child you would like to apply for?*

YesNo
Third Child's First Name
Date of Birth

DayMonthYear
Program

ThimbleberriesHuckleberriesBlackberriesSalmonberriesFamily ClassAfter-schoolSummer Camp
Have you applied for scholarships from Heartwood before?*

YesNo
General Financial Information

Please fill out the following information to help our Family Empowerment coordinators make fair, impartial and compassionate decisions that will benefit us all.
What is your anticipated total tuition for the Heartwood program(s) without scholarship?*
What amount of scholarship would make this program work for your situation?*
What is your family's annual household income? *
Upload your most recent Tax Return for you and your child's other parent. Blackout the social security numbers.*

Browse Files

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How many people are in your household?*
Do you foresee your financial situation changing in the next 6 months?*

YesNo
Please explain*
Other Circumstances

Do you have any extenuating circumstances that are affecting your family's finances that you would like us to take into consideration?
Circumstance:
Write a short paragraph about why attending Heartwood Nature Programs is important to your family and how you see it benefiting your child/children:*
Signatures
I hereby certify that all of the information in this application is true and accurate to the best of my knowledge.
Signature*

Clear
Should be Empty:

Heartwood Scholarship Application

Personal Information

General Financial Information

Other Circumstances

Signatures