ACTIVE LEARNING After School Program Application

1. All applicants must submit a completed scholarship application form along with the required financial documentation to demonstrate financial hardship or doctor's note required for extraordinary circumstances.

2. Acceptable financial documents may include tax returns, W-2 forms, pay stubs, or a letter from an employer verifying income.

3. If applicable, applicants should also provide documentation of any government assistance they receive, such as food stamps or housing assistance.

4. All documents must be current and reflect the applicant's current financial situation.

5. Any fraudulent submission of documents will result in disqualification from the scholarship selection

6. All submitted documents will be kept confidential and used solely for the purpose of evaluating the applicant's financial need for the scholarship.

Instructions: Please complete sections 1-4 (section 3 either financial information or extreme medical condition) of this application. Incomplete applications will not be considered.

Applicants must submit the following required financial documentation to demonstrate financial hardship:

1. Financial Documentation: Acceptable documents include:

Pay stubs A letter from an employer verifying income 2. Government Assistance: If applicable, provide documentation of any government assistance received,

Food stamps Housing assistance 3. Additional Information: Describe any other financial circumstances you feel the scholarship committee

If applying due to an extreme medical condition, please provide the following:

1. Doctor's Note: A note from a licensed medical professional detailing the medical condition and its impact on the child and/or family. 2. Medical Documentation: Any additional relevant medical documents or records that support the application.

Note: All documents must be current and reflect the applicant's current financial/medical situation. Any fraudulent submission of documents will result in disqualification from the scholarship selection process. All submitted documents will be kept confidential and used solely for the purpose of evaluating the applicant's financial/medical need for the scholarship.

 

Proof of Household Income (e.g., recent tax return, pay stubs)

Documentation of government assistance (if applicable)

Doctor's note and medical documentation for extreme medical conditions (if applicable)

Any additional documents you feel support your application

 

By signing below, I certify that the information provided in this application is true and accurate to the best of my knowledge. I understand that any false information will result in the disqualification of my application.

For any questions regarding this application, please contact Hiba Shublak at 714.717.4534.