My signature, below, certifies I have read and understand the following: (1) I have provided all requested information that applies to me and my household members. (2) I have provided verification of income of all household members with the most recent two months' pay stubs and/or all other income and bank statements. (3) If I have any dependent children listed, I have provided verification of recent child support payments or verification that I do not receive child support (contact Division of Child Support Enforcement at 253-597-3700). (4) I have provided supporting documentation for the extenuating circumstances described above. (4) I understand this application will be voided 30 days after the review is completed if I do not enroll in a Child Care program at the Y. (5) I understand that the scholarship will expire and the rate will be raised to the full Child Care rate if the review paperwork is not turned in before the expiration date. (6) I understand that scholarships do not apply to drop-in, registration, or late fees.
I declare the statements above are true and complete to the best of my knowledge. I understand any misrepresentation on my part may disqualify me from receiving a Y Experience Scholarship. I hereby authorize verification of information given, and I agree to provide any and all requested information needed to evaluate my need for financial assistance. I understand a review of my financial situation and circumstances will be periodically conducted at the request of the Y to verify my continuing need for assistance.