24/25 Student Activities Reimbursement Request

Student Activities Reimbursement Request

This form is an application for limited first-come first-served scholarships for a one-time $150 student activity participation fee per full-time BWA student. Currently approved activities include but are not limited to: piano lessons, karate lessons, sports' costs, gym memberships, boy scouts, girl scouts, art classes, science lab activities, etc. Please complete one request per student.
Student Name*

First NameLast Name
Parent Name*

First NameLast Name
Advisory Teacher Name*

First NameLast Name
E-mail*
Mailing Address*

Mailing Address

Mailing Address Line 2

CityState

Zip Code
Phone Number*

Area CodePhone Number
Upload receipt/proof of payment below. Receipt must be included for reimbursement to be processed. Please note: No receipt required for those that qualify for free and reduced however you may be asked to provide a receipt at a later date.

Upload a File

Cancelof
Have you submitted an application and qualify for the free and reduced program:
By selecting ‘Yes’ I confirm that the activity reimbursement funds will be used for the sole benefit of my child’s participation in an extra-curricular event(s) during the current school year and that I may be asked to provide a receipt and/or proof of participation at a later date.
How does this activity enrich the students current activities with Baker Web Academy?*
Waiver Agreement

Please read (do not complete) the activity waiver: https://bit.ly/activitywaiver
By submitting this application and signing below I certify that I have read, fully understand and will abide by the BCS Activity Waiver Agreement:

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For assitance submitting this form please contact: kbruce@bakercharters.org
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