Recess Play Scholarship Application Form

Recess OKC

9 N.E. 9th Street, OKC, OK, 73104

Hello@RecessOKC.com

www.RecessOKC.com

405-698-1403
Play Scholarship Application
Please read about Recess OKC and our services before applying and follow the instructions carefully before submitting your application.

Learn about Recess at RecessOKC.com
Child's Information
Full Name*

First NameLast Name
Birthday*

MonthDayYear
Gender

MaleFemale
Parent/Legal Guardian's First & Last Name
Full Name*

First NameLast Name
Contact Number*
Email *
Where the confirmation will be send to
Parent/Legal Guardian Home Address *

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Occupation*
Please list one of your social media handles if applicable
Our program will open two scholarship options this year for one adult and one child per family. Join our mailing list for more scholarship options to open as funds for this program grow.

PLEASE READ

Scholarship option A.

Play Scholarship A will include 1 Shared workspace & 1 childcare reservation at 50% off the membership rate. ( This option includes childcare M-F 9 am-4 pm )

Org. Membership rate $1,400/mo. Scholarship rate $700/mo.

Scholarship option B.

Play Scholarship B will include Your choice of membership Yellow, Blue, or Green, at 50% off.

Org. Green/Virtual Office $199/mo. Blue Open Desk $299/mo. Yellow Reserved Desk $399/mo.

Scholarship rate. Green Virtual Office $100/mo. Blue Open Desk $199/mo. Yellow Reserved Desk $299/mo. (This option Green, Blue or Yellow members add on childcare for $10/hr.)
Which membership would you like to join?*

Option AOption B
When would you like to start your membership?*

MonthDayYear
Date
Let us know your reasons for applying for a scholarship, with emphasis on your financial situation and needs of your child(ren). *

0/300
Please attach your family's most recent tax return for income verification & copy of photo I.D.*

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HOUSEHOLD INFORMATION

Your household must meet the following requirements to qualify for Recess financial assistance.

Household size of 2 - Total income below $60,000
Household size of 3 - Total income below $70,000
Household size of 4 - Total income below $80,000
Household size of 5 - Total income below $90,000
Household size of 6 - Total income below $100,000
How Many people are in your household?*

2345
What is the estimated total income for your household?*

income below $60,000income below $70,000income below $80,000income below $90,000income below $100,000
REFERENCES

Please provide contact information for two references. They should have knowledge of your employment status and financial situation and should not be a family member or relative. One of your references must be a professional reference.
Please include: Reference 1 Name, Relationship, Email, Contact Number **
Please include: Reference 2 Name, Relationship, Email, Contact Number **
How did you hear about the Recess Play Scholarship?*

FacebookInstagramNewsFriendOther
E-Signature
By signing the space below, you are certifying that all information is correct and that you are the person completing this application.
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Play Scholarship Application

Child's Information

Parent/Legal Guardian's First & Last Name

E-Signature