Scholarship Form - Sports Club Naples Page 2
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3Household Information:
To determine your childcare scholarship, we need to have information about the monthly income received by all members of
•
your household.
List ALL members of yours household, even if they do not have an income.
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Income includes (but is not limited to), earned income, child support, SSI, Unemployment, Worker’s Compensation, and/or
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money or benefits received from any other source.
Verification of income received/ earned is required. Documentation includes: copies of checks, money orders, letters of
•
benefit awards, and tax forms.
Documentation of the last 4 weeks must be included.
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If no income is received by a household member, list zero as their income.
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Adult Members of Household:
*Include ALL adult members of the household in this section (if they do not receive income, list as “zero”).
Full Name
Full Name
Social Security #
Social Security #
Date of Birth
Date of Birth
Male or
Male or
Place of Employment
Place of Employment
Monthly Income
Monthly Income
Female
Female
Minor Members of Household:
*Include ALL Minor members present in the household (list child support under monthly income).
Male or
Grade
Monthly Income
Full Name
Social Security #
Date of Birth
School Attends
Female
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