Boys & Girls Club Scholarship Form

Boys & Girls Club Scholarship Form

Please be advised that scholarship funds are limited. Scholarships are awarded on a case-by-case basis.
Parent/Guardian Name

First NameLast Name
Employer
Household Annual Income
ALL income in the household regardless of relation to child.
Household Size
All Adults and Children residing in the household regardless of relation to child.
Email
example@example.com
Phone Number

Area CodePhone Number
Which Club will your child(ren) attend?
Name & age of Child
School
Name & age of Child
School
Name & age of Child
School
Is the above named child(ren):
Please explain why your child(ren) should be considered for scholarship assistance:
Scholarships were previously based on income which was substantiated with paystub.
Household size was based on the honor system.
Unfortunately, people have been taking advantage of the program.
Our scholarship funds are not unlimited, we are not funded by the government like a school.

Going forward in order to receive a scholarship parents/guardians will need to:
1) Complete the application
2) Provide tax return
3) Complete the "How can I Help" question

Scholarships are reviewed and awarded by a committee and awarded based on need.

Need is determined by:
Financial need
Will the child be left at home, or are there adults available
Stability of household
Would you be willing to volunteer to help the Club with a project?

Other
Please attach most recent tax return for ALL adults in the household.

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Which Program are you applying for:
By signing below, I acknowledge that the income and household size is true and correct. I understand that scholarships may be revoked at any time for any reason. I acknowledge that monthly membership fees are due at the beginning of each month. Failure to stay current on my account may result in my scholarship being revoked. I understand that scholarships are only good for the monthly fees and will not apply to "Drop Days" or "Weekly Fees". I understand that the scholarship is only valid for the program I am applying for (i.e., afterschool or summer). I understand that I must reapply at the end of each session if I still need financial assistance.
Signature
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