Youth Financial Assistance Application

Youth Financial Assistance Application

Full Application
In 2024, Join Hands Ministry launched a new initiative aimed at supporting the youth of Perry County. This program includes a variety of components to foster the growth and development of young people in our county.

There are three main areas of support: extracurricular activity funding, youth STEM workshops, college/career readiness support.

What the applicant needs to know:
- Youth must be a Perry County resident
- Youth must be 18 years of age or younger
- The application includes a parent/guardian section
- The application includes a section about the youth
- Financial assistance is not guaranteed
- Assistance will be based on the strength of the application, available funding, and demonstrated need
How does an applicant apply:
- Preferably, a youth-serving organization (school, sports association, booster club, camp, etc.) would complete this application on the youth's behalf
- Complete the entire application
- All partial applications will not be considered, no exceptions
- Referring organization will be contacted for verification
- All verfied applications will be forwarded to a JHM committee for review
- A letter of reference will be required unless there is a sponsoring organization
What to expect:
- All completed and verified applications will be reviewed and processed within 2-4 weeks after submission
- If the application is approved for funding, a representative of JHM will contact the parent/guardian
- If the application is denied, an email will be sent to the parent/guardian
By checking this box, you are confirming that you have read and understand the conditions of the program.

YesNo

YesNo
Please upload application for program participation*

Cancelof

Referral Information
Name of referring organization:*
Website:*
Business Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name of staff person making referral:*

First NameLast Name
Job Title:*
Office email address:*
example@example.com
Work phone number:*
Please enter a valid phone number.Format: (000) 000-0000.
Please indicate why you believe this is a deserving youth:*
Phone Number (best number to reach you)*
Please enter a valid phone number.Format: (000) 000-0000.

NOTE: Application requires an upload of proof of residency for parent/guardian
YesNo
Sorry, applicant is not eligible for this program.
Upload proof of Perry County residency*

Ex. Valid driver's license, address change yellow card, current lease, copy of a current bill
Cancelof

Applicant Information
Youth Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Youth Date of Birth*

MonthDayYear
Date
Youth's current age*
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Phone Number*
Format: (000) 000-0000.
Parent/Guardian Email (best email to reach you)*
example@example.com
Phone CallEmailText
What school does the youth attend*
Last grade completed*
Ex. 1st grade, 5th grade, Freshman, Senior
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

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

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 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, Suite 1

P.O. Box 335

New Bloomfield, PA 17068
Recommendation Letter One:

Cancelof

Disclaimer, Consent, Authorization, Release of Liability Waiver
I understand that the application is not a guarantee of approvalI understand that personal information provide will be verifiedI understand that information provided may be verified by Join Hands Ministry contacting the referring organization and any other organizations that have been listed in this application.I certify that the information provided in this application is true, complete, and accurate to the best of my knowledge.I understand that providing false or misleading information may result in disqualification for receiving service or penalties as determined b the applicable policies or regulationsI understand there is risk of my youth being injured in sports or extracurricular activities. 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.
Parent / Guardian Signature*

Clear
Should be Empty:

Youth Financial Assistance Application

Referral Information

NOTE: Application requires an upload of proof of residency for parent/guardian

Applicant Information

To be Completed by Youth

To be Completed by Parent / Guardian

Disclaimer, Consent, Authorization, Release of Liability Waiver