LEAP Application

Recipient Information
ELIGIBILITY FOR RECIPIENTS
- Must reside in Marion or Polk County of Oregon,
- Must have taken classes in dance for at least 1 year,
- Must be between 3 through 17 years of age,
- Must have a good dance attendance record,
- Must have a financial need based on attachments below,
- Must be currently enrolled in a dance class.
Please have these documents ready before you begin the application process. You will need to attach copies of at the end of this application in a pdf format. Only pdfs will be accepted.
- Proof of residency with legal street address
- Proof of household income for the parent(s) and /or legal guardian in which the student resides. This includes one of the following:
     1. Signed copy of Federal Income Tax Form with W2’s attached or
     2. SSI Notification Medical Record or
     3. TANF Notification
Name of Dancer*

First NameLast Name
Age of Recipient*
Birth Date*

MonthDayYear
Date
Gender*

FemaleMale
Ethnic Background

African AmericanAsianCaucasianHispanicMiddle EasternNative AmericanOther
Has the student received tuition scholarships in the past?*

YesNo
How much?*
When did you receive your last scholarship?*
How long and what styles of dance studied?*

0/100
What performance experience has the dancer had?*

0/100
Tell us what dance means to you*

0/100
What kind of dance do you like best and why?*

0/100
What is it like to study dance? Why do you like it?*

0/100
What is your dream about dancing in the future?*

0/100
Parent Information
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Cell Number
Please enter a valid phone number.
Are you?*

MarriedDivorcedSingleWidowedOther
Which benefits do you receive *

WelfareMedi-CalSSISSANone of the aboveOther
How many family members live at the above address?*
How many people contribute to your household income?*

Just meMe and a spouse or partnerMe and an ex-spouseOther
Where are you employed?*
What is your total household annual income?*
List all sources of household income.*

0/100
Briefly describe your reason for needing a scholarship for your child*

0/100
Tell us about your child and experience with dance. Do you see a future in dance for them.*

0/100
Tell us how and why you support your child’s talent.*

0/100
Attachments

Must be in pdf format only
Income Verification

IRS Tax Return with W2s or SSI Notification Medical Record or TANF Notification
Cancelof
Residency Verification

Medical Record or School Record
Cancelof
I hereby certify that all of the information provided by me in this application (or any other accompanying or required documents) is correct, accurate and complete to the best of my knowledge.*

YesNo
I understand that the falsification, misrepresentation or omission of any facts in said documents will be cause for denial of a scholarship regardless of the timing or circumstances of discovery.*

YesNo
I understand that submission of an application does not guarantee a scholarship.*

YesNo
I understand that upon receiving a scholarship, I allow LEAP to use any photos of my child in their promotional advertising.*

YesNo
By typing and signing my name, I agree to all of the conditions set forth in this application.*
Date

MonthDayYear
Date
Hour MinutesAM/PM Option
Signature*

Clear
Should be Empty:

Recipient Information

Parent Information

Attachments