HARDSHIP DISCOUNT APPLICATION

HARDSHIP DISCOUNT APPLICATION
Hardship/Need Based Application Fee Waiver Form (Grade K-5)
The Learning Center (STS Academy) is aware and Concerned about parents whose financial limitations affect their ability to pay for STS Acaddemy year around programs. Funding provided by STS Academy and its community partners has been made available to assist low and very low income houldholds to take part in the STS year around programs.

To be eligible for consideration, this form and supporting income documentation must be submitted.

Every applicant must submit proof of income.
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.
Work Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Employer
Your Occupation
Email
example@example.com
Some examples of Hardship documentations:

Most Recent Tax Return & W-2 or 1099Current Unemployment check stub or statementBenefit StatementNotice of Action
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?

RentOwn
How long have you lived at your current address?
What language is usually spoken in your household?

EnglishSpanishOther
What language is usually spoken in your household?
Do you receive County, State or Federal assistance for Low-Income status?

YesNo
Do you care for foster children?

YesNo
Session or programs your child will attend

All Day 6AM - 6 PM (Mon - Fri)AM OnlyPM or After School OnlyExtended AM or PM programs
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?
Upload Documentation Here:

Cancelof
Signature

Clear
Signature

Clear
Should be Empty:

HARDSHIP DISCOUNT APPLICATION

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

STUDENT INFORMATION

PARENT INFORMATION