A2SCS Sliding Scale Family Support Scholarship Program Application

A2SCS Sliding Scale Family Support Scholarship Program Application

Complete the application and upload the required documentation to be reviewed for temporary childcare tuition assistance.
Child Information
Child First Name
Child Last Name
Date of Birth

MonthDayYear
Date
Age Group
Requested Start Date

MonthDayYear
Date
Location Applying For
Parent/Guardian Information
Parent/Guardian Full Name

First NameMiddle NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Mailing Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Employment Status
Employer
Household Size
Number of Children Needing Childcare
Financial Need and Scholarship Request
Reason for requesting assistance
Weekly tuition amount
A2SCS Tuition
Amount family can pay weekly
Requested scholarship amount
Does your family receive any childcare subsidy or assistance?
Required Documentation
Proof of Income

Cancelof
SNAP or Assistance Letter (if applicable)

Cancelof
Childcare Scholarship or Subsidy Paperwork (if applicable)

Cancelof
Other Supporting Documents

Cancelof
Scholarship Duration
Scholarship Duration: 6 months
Acknowledgment
Scholarship Term Approved

Other
Program Policies and Agreement
Program agreement statements
Signature and Date
Signature
Date

MonthDayYear
Date
Should be Empty: