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.
How did you hear about Heartwood?
Parent/Gaurdian 1*

First NameLast Name
Parent/Gaurdian 1 Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Are you experiencing homelessness? If yes, please share your circumstances:*
Parent/Gaurdian 1 Email*
example@example.com
Parent/Gaurdian 1 Phone Number*

Area CodePhone Number
How did you hear about us?
Parent/Gaurdian 2 Name

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

Area CodePhone Number
Parent/Gaurdian 2 Address (if different than Parent/Gaurdian 1):

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
1st Child's Name*

First NameLast Name
1st Date of Birth*

MonthDayYear
Program for 1st child:*

Thimbleberries - parent/child ages 0-3Huckleberries - ages 3-5Salmonberries - ages 6-11 homeschoolWildlings - ages 10-13 homeschoolCedar Seekers - parent/children ages 3-7After-schoolSummer Camp Wildwood (ages 6-11)Summer Camp Bigleaf (ages 4-6)Summer Camp Heronswood (ages 5-9)Winter Break CampMid-Winter Break CampSpring Break CampOther
Do you have a second child you would like to apply for?*

YesNo
2nd Child's Name*
2nd Date of Birth*

DayMonthYear
Program for 2nd child:*

Thimbleberries - parent/child ages 0-3Huckleberries - ages 3-5Salmonberries - ages 6-11 homeschoolWildlings - ages 10-13 homeschoolCedar Seekers - parent/children ages 3-7After-schoolSummer Camp Wildwood (ages 6-11)Summer Camp Bigleaf (ages 4-6)Summer Camp Heronswood (ages 5-9)Winter Break CampMid-Winter Break CampSpring Break CampOther
Program

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

YesNo
3rd Child's Name*
3rd Date of Birth*

DayMonthYear
Program for 3rd child:*

Thimbleberries - parent/child ages 0-3Huckleberries - 3-5Salmonberries - ages 6-11 homeschoolWildlings - ages 10-13 homeschoolCedar Seekers - parent/children ages 3-7After-schoolSummer Camp Wildwood (ages 6-11)Summer Camp Bigleaf (ages 4-6)Summer Camp Heronswood (ages 5-9)Winter Break CampMid-Winter Break CampOther
Do you have a fourth child you would like to apply for?*

YesNo
4th Child's First Name*
4th Date of Birth*

DayMonthYear
Program

ThimbleberriesHuckleberriesBlackberriesSalmonberriesFamily ClassAfter-schoolSummer Camp
Program for 4th child:*

Thimbleberries - parent/child ages 0-3Huckleberries - ages 3-5Salmonberries - ages 6-11 homeschoolWildlings - ages 10-13 homeschoolCedar Seekers - parent/children ages 3-7After-schoolSummer Camp Wildwood (ages 6-11)Summer Camp Bigleaf (ages 4-6)Summer Camp Heronswood (ages 5-9)Winter Break CampMid-Winter Break CampSpring Break CampOther
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 the most recent year's 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*

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Should be Empty:

Heartwood Scholarship Application

Personal Information

General Financial Information

Other Circumstances

Signatures