Scholarship Application Form

Scholarship Application Form
LASER is committed to making our programs affordable. We realize there may be circumstances where payment of the entire fee is a hardship. We strive to make our programs available to as many children as possible, given our available and limited resources.

Scholarships are available for after-school and summer camp day camp. We are unable to provide scholarships on school-year day camps, Parent Night Out, and other special event care.
To assist families in need, we have the following requirements:
1. A one-time new student registration fee of $100 is required for each child. (In extreme circumstances, a reduction of the fee may be possible.)
2. Families who meet established income qualifications are eligible for up to a 50% scholarship for program fees and summer camp fees.
3. Payment plans are available, and must be worked out in advance of the program with the Executive Director. All payment plans must be approved by the Executive Director and payments must be kept up-to-date.
4. Scholarships are given on the basis of eligibility and the availability of funds. No scholarships are guaranteed. New applications are required for EACH school year and summer for which you are seeking assistance.
5. You must apply to DSHS and City of Seattle for Child Care Assistance before LASER will grant a scholarship.
Scholarship Application Procedures
1. Fill out and submit an application form to the LASER Executive Director.
2. Along with your application, provide a complete copy of last year’s tax return (all Schedules) OR the last two months of current employment pay stubs. (Your application cannot be processed without this documentation.)
3. Your application will be reviewed and your finances compared to standard income guidelines.
4. Submit proof of application (and proof of denial or wait list status) from DSHS, City of Seattle, and Best Starts for Kids. Please see contact information below for both subsidy programs. (Your application cannot be processed without this documentation.)
5. Please allow 14 business days from the date LASER receives your completed application (including documentation of your tax return/income and declination letters from subsidy programs).
Department of Social and Health Services (DSHS)
Contact Information—you may apply over the phone or online:
Website
Customer Service Call Center: 1-877-501-2233

City of Seattle – Human Services Dept. Child Care Assistance Program
City of Seattle Human Services Department
Child Care Assistance Program
700 5th Avenue, Suite 5800, PO Box 34215, Seattle, WA 98124-4215
206-386-1050
Email: comprehensivechildcare@seattle.gov
Website
Eligibility screenings are only available by calling the Seattle Human Services Department’s Child Care Assistance office at 206-386-1050.
For services in other languages, call:
Mienh — 206-684-0605
Spanish — 206-386-1012
Tagalog — 206-386-1011
TDD — 206-233-2778
Interpretive services can be arranged for other languages.

Best Starts for Kids

Phone/Text:206-208-6865

Email: support@bskchildcare.org

Website
Childcare program for which you are seeking scholarship? (select all that apply)*

LASER at Laurelhurst After-school ProgramLASER at Bryant After-school ProgramSummer CampSchool-Year Day Camp (in partnership with the Robby Saunders Memorial Fund)Parent Night Out (in partnership with the Robby Saunders Memorial Fund)
Household Information:
Number of parents or guardians in household*
Parent/Guardian #1 Name:*

First NameLast Name
Parent/Guardian #1 Phone:*

Area CodePhone Number
Parent/Guardian #1 Email:*
example@example.com
Parent/Guardian #2 Phone:

Area CodePhone Number
Parent/Guardian #2 Email:
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Total annual income for household:*
Important: As proof of income you must provide a complete copy of last year’s tax return (all schedules) or the last two months of current employment pay stubs.
List the names and ages of ALL children (dependents under 18 years of age) in your family:
Child #1 Name*

First NameLast Name
Parent/Guardian #2 Name:

First NameLast Name
Child #1 Birthdate*

MonthDayYear
Date
Child #2 Name

First NameLast Name
Child #2 Birthdate

MonthDayYear
Date
Child #3 Name

First NameLast Name
Child #3 Birthdate

MonthDayYear
Date
Which, if any, of the following do you currently receive?*

Temporary Assistance to Needy Families (TANF)Free or reduced school lunchesSubsidized HousingFood StampsSocial Security Supplemental Security IncomeDisability Lifeline (Washington State)State Family Assistance (SFA)General AssistanceOther (e.g., unemployment, disability, etc.)None
The following questions are optional. The answers provide a more complete picture of your family so that we may better meet your child care needs.
Parents Marital Status

MarriedUnmarriedDivorcedSeparated
Number of persons employed in the household:
Parent/Guardian #1:
Age
Highest level of education completed
Occupation
Employed?

YesNo
Is there any other information you would like to share regarding your situation?
Parent/Guardian #2:
Age
Highest level of education completed
Occupation
Employed?

YesNo
Required Documentation

The following documentation is required to process your scholarship application. If uploading a digital copy is a burden, you may turn in a paper copy at LASER. However, we will not be able to process your application until all required documentation has been turned in.
Complete copy of last year's tax return (all schedules) OR the last two months of current employment pay stubs.*

Browse Files

Cancelof
Proof of application (and proof of denial or wait list status) from DSHS*

Browse Files

Cancelof
Proof of application (and proof of denial or wait list status) from City of Seattle CCAP*

Browse Files

Cancelof
Scholarship applications are reviewed upon receipt of this application and all required forms and documents (the “completed application”). You will be notified of a determination within 7 business days from the date LASER receives your completed application. If your income or household size changes, you must promptly report such changes as they occur, as it may affect your eligibility. Scholarships apply ONLY to the school year or summer being requested. You must reapply for a new scholarship for each school year and summer requested.
I have read and understand the above. I understand that all participants in LASER programs must pay a one-time registration fee of $100. A deposit is also required at registration for: (1) one month of care (for school-age before/after school care); or (2) one week of care (summer camp). I understand my deposit will be prorated if I receive a scholarship.*

Yes
I understand a maximum scholarship discount of 50% may be applied to LASER after-school and summer camp programs. In unusual circumstances, additional discounts may be available based upon a review of income statements and information provided to the LASER Board.*

Yes
I have read the above and verify that all information is true and correct. If a scholarship is granted or pending, I will promptly report to LASER any changes in my financial status.*

Yes
For Office Use Only:
Approved for:

50% of After-school Program25% of After-school Program50% of Summer Camp25% of Summer CampDenied
Denial Reason
Approved by:
Date

MonthDayYear
Date
Should be Empty:

Scholarship Application Form

Required Documentation