Application For Scholarship Assistance Form - Greater Carbondale Ymca printable pdf download

Application For Scholarship Assistance Form - Greater Carbondale Ymca

Greater Carbondale YMCA

Application for Scholarship Assistance

Please fill out the following information and attach the necessary documents (photocopies ONLY) and

return to the Executive Director located at 82 N Main St Carbondale, PA 18407. A letter stating your

reason for your request for Scholarship Assistance must accompany this application. An interview

may be required prior to the approval of this scholarship application. Balance of the allocation must

be paid in full. Exceptions to this policy are to be made only by the Executive Director.

PLEASE PRINT ALL INFORMATION!

Date of Application:_______________________ Social Security Number:__________________

Name:__________________________________ Home Phone:__________________________

Address:________________________________ Work Phone:___________________________

City:___________________________________ Cell Phone:____________________________

State:___________ Zip:__________________ Date of Birth:__________________________

Place of Employment:______________________ How Long Employed?:____ Yrs_____ Mths

E-Mail:_______________________________________________________________________

Family Size: ______ Adults

______ Children

Spouse/Children's Name

Age

Sex

School/Employer

Date of Birth

Are You a Single Parent Household?

______ Yes

______ No

Application for Scholarship Assistance is for:

______ Membership

______ Program

______ Preschool

______ Other: ______________

Have You Ever Applied for Scholarship Assistance at any YMCA? ______ Yes ______ No

If Yes, Which YMCA? _________________________________________________________

What Volunteer Service Did You Provide? ______________________________________________

How Many Volunteer Hours Did You Provide? ___________________________________________

Application For Scholarship Assistance Form - Greater Carbondale Ymca