Youth Financial Assistance Application

Youth Financial Assistance Application

Full Application
Join Hands Ministry, Inc. (JHM) is a non-profit organization that is dedicated to serving the residents of Perry County, PA. The newly established Youth Assistance Program encompasses four (4) areas of focus: Direct Financial Assistance, Education, Guidance and Support, and Empowerment. This program is designed to support youth through the age of 18 in need of financial assistance to participate in sports, music, art, and other youth development programs as well as college preparation.

Should you receive funding through the Join Hands Ministry Youth Assistance Program, we ask that you fulfill the requirements and obligations that the organization you enroll in expects of you. Please be sure you can uphold their requirements before accepting the gift.

Join Hands Ministry is a non-profit organization that is funded by the generous donors of the county. It is a great honor that you are receiving this gift, and we ask that you honor and respect your community and Join Hands Ministry in honor of those who are supporting you.

We also ask if you (applicant or family) volunteer at least 5 hours to the organization you will be enrolled with. These organizations thrive on volunteers, and it is an easy way to give back. Failure to uphold this may result in the loss of current and/or future sponsorships.
Do you agree that if you receive funding through Join Hands Ministry's Youth Assistance Program, you will fulfill the requirements and obligations of the organization you enroll in and volunteer (applicant or family) at least 5 hours to the organization as requested in the above statement?*

YesNo
Great!! We love that you are willing to fulfill the organization's requirements and volunteer to better support the needs of the community!
Community organizations thrive on volunteering and the support of each other. As a way to ensure that our support comes around in full circle we require that each participant is supporting the organization that they enroll. At this time, it does not appear that you are eligible to apply for our program. When you are able to commit to supporting the organization you wish to enroll, please come back to apply.

To apply for assistance you must complete this application (in full), have a sponsor and parent/guardian sign and submit to Join Hands Ministry. Should you need special accommodations or you have questions, please call us at 717.582.7844
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth*

MonthDayYear
Date
Phone Number*
Email*
example@example.com
Last Year Completed in School*
For what activity are you requesting financial assistance?*
Ex. Camp, Instrument rental fees, Equipment/uniform not provided by school or association
What amount are you requesting?*
Ex. $25, $50, $75

To be Completed by Youth
If I receive financial assistance, I agree to send a thank you letter to my sponsor and I agree to follow all guidelines and policies set by the organization in which I am participating.
In one paragraph, please tell us about yourself.*
To be Completed by Student
In one paragraph, please state "Why I want to attend/participate in..."?*
To be Completed by Student
Youth's Signature*

Clear
Release of Liability: There is a risk of being injured that is inherent in all sports activities and may be present in activities associated with other activities covered by this scholarship. Some of the injuries include, but are not limited to, the risk of fractures, paralysis, or even death. I expressly assume the risk of injury, death, and/or illness arising from any cause, and agree to waive the right to pursue any claim against Join Hands Ministry, Inc., any affiliation of Join Hands Ministry, Inc., the Board of Directors, and any staff or volunteer of Join Hands Ministry.
By signing below, I understand and agree to the release of liability as stated above.
Youth's Signature (18 years or older - Please sign)

Clear

To be Completed by Parent / Guardian
Please make a detailed statement describing why your youth is in need of financial assistance. *
To be Completed by Parent / Guardian
What is your occupation / job title? *
What is the occupation of your spouse/significant other/partner? *

What is the combined/total annual household income: Check the appropriate box. *

	Under $20,000	$20,001-$30,000	$30,001-$40,000	$40,001 -$50,000	$50,001 and up
Income

The amount of assistance is based off a rolling tier.

The items listed below are to be transferred from your 2023 1040/1040EZ Tax Return: (Include spouse/domestic partner's information if applicable).
Number of Dependents*
Line 6C on 1040, Line 5on 1040 EZ or Line 6C on 1040A.
Adjusted Gross Income*
Line 37 on 1040, Line 4 on 1040 EZ or Line 21 on 1040 A.
Total Income*
Line 22 on 1040 or Line 15 on 1040 A.
List Special Circumstances (If Any)
Do you have other youth attending/participating in extracurricular activities this year?*

YesNo
By signing this document, I agree that the information is accurate.
Parent / Guardian Name*

First NameLast Name
Parent / Guardian Signature*

Clear
Release of Liability: There is a risk of being injured that is inherent in all sports activities and may be present in activities associated with other activities covered by this scholarship. Some of the injuries include, but are not limited to, the risk of fractures, paralysis, or even death. I expressly assume the risk of injury, death, and/or illness arising from any cause, and agree to waive the right to pursue any claim against Join Hands Ministry, Inc., any affiliation of Join Hands Ministry, Inc., the Board of Directors, and any staff or volunteer of Join Hands Ministry.
By signing below, I understand and agree to the release of liability as stated above.
Parent / Guardian Signature*

Clear

References

To be completed by someone other than a family member. (Ex. Teacher, School Administrator, Scout Leader, Pastor, etc.) Please include a brief statement made by the reference of your choosing, contact information for reference, a reference signature, and the relationship to the youth. References can be mailed to the our office.

Please make a brief statement describing why this youth deserves a financial assistance.

References can be sent using the file upload tabs below or can be mailed to the our office.

Join Hands Ministry

Attn: Youth Assistance Program Manager

51 S. Church Street

P.O. Box 335

New Bloomfield, PA 17068
Recommendation Letter One:

Cancelof

Please note that financial assistance is not guaranteed and will be awarded based on the strength of your application, available funding, and demonstrated need. All applications are confidential; the information provided will not be shared outside of our team. Our financial assistance committee reviews applications at least once per month, allocating funds based on donations and grants received. We will notify applicants of any award decision within 2-4 weeks. Supporting those with the greatest need remains the primary goal of the Youth Financial Assistance Program.
Should be Empty:

Youth Financial Assistance Application

To be Completed by Youth

To be Completed by Parent / Guardian