JYP

JACKSON

YOUTH PROGRAM

FINANCIAL ASSISTANCE APPLICATION

JACKSON Youth Program is committed to providing quality experiences for youth regardless of income. Anyone who can demonstrate a need for financial assistance is encouraged to apply.

Awards for financial assistance are available in full and partial denominations and are distributed on a rolling basis based on availability. In an effort to provide assistance to as many members as possible, assistance may be limited to one week per youth.

Please complete application online or dowload and send to Information@JacksonYouthProgram.org
Please note: We respect all privacy, and all information will remain confidential.
Members Name
Birthdate & Age
School & Fall 2023 Entering Grade
Parent/Guardian Name
Address
Phone
Email
example@example.com
Has youth attended JACKSON Youth Program before?

YesNo
Select Scholarship Request:
Enter Scholarship Request Amount
Please indicate which program and dates that you are applying for ie. After-school program, summer program or winter break
Financial Information:
Total annual family or household income (salaries and other):
Number of individuals in household:
Please note: We may ask for a copy of your most recent tax return, most recent pay statements and/or proof of income.
Other relevant financial information:
STATEMENT OF FINANCIAL NEED:
Please write a short statement describing your family's financial situation. Be sure to include any special circumstances you would like us to consider?
Benefit of Attending JACKSON Youth Program:
Please write a short statement describing how this youth would benefit from our program in relation to your request for financial assistance.
I attest that all information provided within the application is true and current as of this date.

MonthDayYear
Date
BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Parent/Guardian Signature

Clear
Parent/Guardian Print Name
Should be Empty:

Select Scholarship Request:

Financial Information:

STATEMENT OF FINANCIAL NEED:

Benefit of Attending JACKSON Youth Program: