HARDSHIP DISCOUNT APPLICATION

HARDSHIP DISCOUNT APPLICATION
Hardship/Need Based Application Fee Waiver Form (Grade K-5)
The Learning Center (STS Academy) recognizes and is sensitive to the financial challenges some families may face in accessing year-round programs. Through funding provided by STS Academy and its community partners, limited financial assistance is available to help low- and very low-income households participate in STS Academy’s year-round programs.

To be considered for assistance, applicants must complete and submit this form along with all required supporting income documentation.

Proof of income is required for all applicants.
STUDENT INFORMATION
STUDENT NAME

First NameLast Name
STUDENT I D #
GRADE
Please let us know if you are a first time participant or have been a member of STS Academy in a previous program.
Have you received financial assistance for any STS Academy Program prior to this program. If yes, please provide any information on the time of year and program your child(ren) participated in.
SCHOOL ATTENDING
SCHOOL DISTRICT
PARENT INFORMATION
PARENT NAME

First NameLast Name
Cell/HomePhone Number
Please enter a valid phone number.Format: (000) 000-0000.
Work Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Employer
Your Occupation
Email
example@example.com
Some examples of Hardship documentations:
What is your annual household income? blanks
How many people live in your home? blank
The number of students to enroll blanks The percent of support your family is requestingblank %.
Do you rent or do you own the place where you live?
How long have you lived at your current address?
What language is usually spoken in your household?
What language is usually spoken in your household?
Do you receive County, State or Federal assistance for Low-Income status?
Do you care for foster children?
Session or programs your child will attend
I (print your name) blanks hereby declare that all information filled out on this form, documentation used to verify that I cannot pay the STS's fee(s), and my financial hardship claim in true and accurate. If not, I understand that any possibility of having my summer fee waived will be voided. I give permission for STS Academy to verify my income and residence. field.
Date: blank form submitted?
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HARDSHIP DISCOUNT APPLICATION

Hardship/Need Based Application Fee Waiver Form (Grade K-5)

STUDENT INFORMATION

PARENT INFORMATION