Ocean Community YMCA YCares - Financial Assistance Program

Size: px
Start display at page:

Download "Ocean Community YMCA YCares - Financial Assistance Program"

Transcription

1 Y scholarships are available to adults, children, and families who are unable to attend the Y or its programs due to inability to pay. A YMCA scholarship is a valuable thing to seek. Because scholarship dollars are limited, applicants are encouraged to pay as much as possible toward the fee. What makes YCares possible? Through proceeds from the Reach Out to Youth Campaign, financial assistance is available for children, adults and families in need. Who can participate? YCares is available to anyone who meets the financial guidelines of the program and has the desire to participate in Y programs and services. What is the philosophy beyond YCares? Ocean Community YMCA s volunteers and staff believe that its programs and services have a positive impact on those who participate and their communities. They believe that these programs and services should be available to everyone who wants to be involved. How can I apply? Complete and return the attached form. Your application will be processed within two weeks and you will receive a notification phone call regarding your subsidy level.

2 The YMCA offers assistance options to ensure that no one is turned away due to financial limitations. Verification of monthly household income is required and must be submitted with this application. You must include at least one of the following items: 1. Most recent year 1040 tax return. 2. Copy of benefits Determination Letters (for Welfare, Free Lunch, SSI). 3. Current, consecutive, pay stubs from the last month. See the YMCA Membership Director with any questions. Additional information may be required in order to determine the appropriate amount of assistance to be awarded (i.e., 3 rd party reference, medical bills, etc.). Funding is made possible for this program through the YMCA Reach Out To Youth Campaign and other contributions. Anyone wishing to contribute to the YMCA should contact their local YMCA Membership Director. Instructions: 1. The participant or parent/guardian must complete the attached financial assistance application. 2. Attach all necessary supporting documents. 3. Sign and return to the YMCA in a sealed envelope addressed to the Membership Director. If all the proper information has been received with a signed application, the YMCA will process the financial assistance request and notify the applicant within two weeks.

3 YMCA Membership Desired (circle applicable category): Adult Young Adult Youth Teen Senior Senior Couple One-Adult Family Two-Adult Family YMCA Programs Applying for: Applicant Name Address City State Zip Phone ( ) Cell ( ) List the name and date of birth for all individuals living in the household who share living expenses (including yourself, spouse, children, etc.) Name DOB Name DOB

4 Monthly Income: Total amount of monthly income before deductions, including wages, salary, public assistance, child support, alimony, social security, unemployment compensation, pension, or retirement income. $ Are you a current member of the YMCA? (circle one) Yes No Why I would like to be a member of the Ocean Community YMCA? Of the full Membership Fee I am willing to pay $ Would you be willing to give a testimonial during our Reach Out To Youth campaign? (circle one) Yes No MUST REDEEM WITHIN 30 DAYS OF RECEIVING THIS AWARD I hereby certify that I have completed all the information requested within this application form, and that all information supplied is true and accurate to the best of my knowledge, and that there is no misrepresentation or omission. I further understand that this application does not constitute acceptance by the YMCA, and that I will be notified as to whether my application for financial assistance has been approved or denied. Date Date Applicant Signature Branch Director or Membership Director

5 FOR OFFICE USE ONLY Percentage Awarded % Date Membership Type or Program Amount F.A. Awarded Due Y Cares Expiration Date: Program % Discount: Notes:

OPEN DOORS FINANCIAL ASSISTANCE. oceancommunityymca.org. The Y: So Much More.

OPEN DOORS FINANCIAL ASSISTANCE. oceancommunityymca.org. The Y: So Much More. OPEN DOORS FINANCIAL ASSISTANCE The Y: So Much More. oceancommunityymca.org Frequently Asked Questions Scholarships are available to adults, children, and families who are unable to attend the Y or its

More information

Oshkosh Community YMCA Youth Care Services 324 Washington Avenue Oshkosh, WI 54901

Oshkosh Community YMCA Youth Care Services 324 Washington Avenue Oshkosh, WI 54901 Thank you for your interest in the Oshkosh Community YMCA Child Care Programs. In order to provide the best possible financial assistance to qualifying families, the Oshkosh Community YMCA Child Care Programs

More information

St. Vincent Apartments 1521 Las Vegas Blvd. North Las Vegas, NV 89101

St. Vincent Apartments 1521 Las Vegas Blvd. North Las Vegas, NV 89101 St. Vincent Apartments 1521 Las Vegas Blvd. North Las Vegas, NV 89101 APPLICATION FOR RENTAL A. Applicant Information DATE Catholic Charities is required to verify that all tenants of the St. Vincent Apartments

More information

DeKalb County Sheriff's Office CIVIL PROCESS COMMUNICATION CENTER CORRECTIONS/JAIL

DeKalb County Sheriff's Office CIVIL PROCESS COMMUNICATION CENTER CORRECTIONS/JAIL ADMINISTRATION OFFICE 815-895-7260 DeKalb County Sheriff's Office CIVIL PROCESS 815-895-7259 COMMUNICATION CENTER 815-895-2155 CORRECTIONS/JAIL 815-895-4177 FAX 815-895-7235 - SHERIFF FAX 815-895-7275

More information

Teddy Forstmann Scholarship Program Application Instructions

Teddy Forstmann Scholarship Program Application Instructions 2015-2016 Application Instructions APPLICATION DEADLINE: FRIDAY, AUGUST 21, 2015,,. Applications postmarked AFTER this deadline may not be awarded. Please be sure to keep in contact regularly with your

More information

Last Name: First Name: Middle Name: Street Address: City: State: Zip Code: Home Phone: Work Phone: Cell Phone: May We Call You at Work?

Last Name: First Name: Middle Name: Street Address: City: State: Zip Code: Home Phone: Work Phone: Cell Phone: May We Call You at Work? City of Walker 205 Minnesota Avenue West PO Box 207 Walker MN 56484 218-547-5501 Employment application We welcome you as an applicant to employment! The City of Walker is an equal opportunity employer

More information

2011 Scholarship Application

2011 Scholarship Application Greater Lafayette www.ywca.org/lafayette 2011 Scholarship Application 01 02 03 04-05 About Us Application Eligibility Scholarship Instructions Sliding Scale Fee Application Greater Lafayette The YWCA Greater

More information

Dear Summer Camp Scholarship Applicant,

Dear Summer Camp Scholarship Applicant, Dear Summer Camp Scholarship Applicant, Thank you for your interest in the Morean Arts Center s summer camp program! Scholarships are an important part of camp at the Morean, as they allow us to help your

More information

Ruth & Norman Rales Jewish Family Services Center for Families & Children 2018 Camp Scholarship Application- Application Date:

Ruth & Norman Rales Jewish Family Services Center for Families & Children 2018 Camp Scholarship Application- Application Date: Ruth & Norman Rales Jewish Family Services Center for Families & Children 2018 Camp Scholarship Application- Application Date: Print name (First Mother): Middle): (Last): _ Age: Did you apply Last Year

More information

LEADERSHIP PROGRAM APPLICATION PACKET

LEADERSHIP PROGRAM APPLICATION PACKET LEADERSHIP PROGRAM APPLICATION PACKET 2017-2018 Our community-based Leadership Program provides a fun, safe and challenging experience for high school juniors (sophomores and seniors by special arrangement)

More information

Patient Name: Date of Birth: Specific medical care needed: Medical Pediatrics Gynecology Obstetrics: If pregnant, how many weeks?

Patient Name: Date of Birth: Specific medical care needed: Medical Pediatrics Gynecology Obstetrics: If pregnant, how many weeks? New Patient Renewal MRN# Dear Patient/Applicant: You are receiving this Patient Financial Assistance Application because you wish to apply for medical care at Mercy Hospital JFK Clinic. In order to accurately

More information

RNDC does not discriminate on the basis of age, race, sex, creed, or disability. Equal Opportunity Lender

RNDC does not discriminate on the basis of age, race, sex, creed, or disability. Equal Opportunity Lender PLEASE PRINT CLEARLY OR TYPE: DEPARTMENT OF BUSINESS AND INDUSTRY HOUSING DIVISION WEATHERIZATION ASSISTANCE PROGRAM APPLICATION A. APPLICANT INFORMATION HOME WORK NAME: PHONE: PHONE: (Last, First, MI)

More information

Do you or anyone you know meet the following qualifications:

Do you or anyone you know meet the following qualifications: INTEGRITY - INNOVATION - COLLABORATION - RESPECT - CELEBRATION - EXCELLENCE GO! GREEN CADRE PROGRAM An opportunity for success Submit your application NOW! Leadership Development Community Service Certifications

More information

The Onsite Foundation

The Onsite Foundation The Onsite Foundation Scholarship Application Instructions The purpose of this program is to provide partial scholarships to individuals who want to attend a personal growth program. Please read this information

More information

Maui Family YMCA FINANCIAL ASSISTANCE PROGRAM GUIDELINES

Maui Family YMCA FINANCIAL ASSISTANCE PROGRAM GUIDELINES Maui Family YMCA FINANCIAL ASSISTANCE PROGRAM GUIDELINES HOW TO APPLY FOR FINANCIAL ASSISTANCE 1. Fill out these forms completely 2. Attached proof of income 3. Submit to YMCA 4. Approval or denial letters

More information

LEADERSHIP PROGRAM APPLICATION FORM

LEADERSHIP PROGRAM APPLICATION FORM LEADERSHIP PROGRAM APPLICATION FORM 2015-2016 Our community-based Leadership Program provides a fun, safe and challenging experience for high school juniors to develop their leadership skills, explore

More information

CHECKLIST OF MANDATORY DOCUMENTS FOR HEAP

CHECKLIST OF MANDATORY DOCUMENTS FOR HEAP CHECKLIST OF MANDATORY DOCUMENTS FOR HEAP Community Action Partnership of Orange County Energy and Environmental Services Department 11870 Monarch Street, Garden Grove, CA 92841 Tel. (714) 839-6199 or

More information

Department: Corporate. Issued by: Kelley Roberson COO & CFO. Approved by:

Department: Corporate. Issued by: Kelley Roberson COO & CFO. Approved by: Subject: Charity Care HAWAII HEALTH SYSTEMS C O R P O R A T I O N Touching Lives Everyday" Policies and Procedures Department: Corporate Issued by: Kelley Roberson COO & CFO Approved by: Policy No.: FIN

More information

Rotary Youth Volunteer Application - (YE - Rotarian Volunteers)

Rotary Youth Volunteer Application - (YE - Rotarian Volunteers) Rotary District Youth Exchange Program Districts 7120, 7150, 7170, 7210 Student Protection Program Rotarian Volunteer Application/Background Check (Rev 7/10) Rotary International has directed that all

More information

Scholarship Application

Scholarship Application Scholarship Application Buddy Pelletier Surfing Foundation Scholarship Application Mission: The Buddy Pelletier Surfing Foundation is to operate for the charitable, educational and humanitarian purposes.

More information

Fall Dear Students, Parents and Guardians,

Fall Dear Students, Parents and Guardians, Fall 2018 Dear Students, Parents and Guardians, Thank you for your interest in the Student/Partner Alliance (S/PA) scholarship program. Our scholarship is intended for motivated students who have already

More information

FINANCIAL ASSISTANCE PROGRAM

FINANCIAL ASSISTANCE PROGRAM FINANCIAL ASSISTANCE I certify that the above information is true and accurate to the best of my knowledge. Further, I will make application for any assistance which may be available for payment of my

More information

Rice County HRA Bridges Application

Rice County HRA Bridges Application Rice County HRA Bridges Application This application is for the Bridges Program only. Read the instructions for each section and answer all required questions. Incomplete applications will slow processing

More information

Whom it May Concern Respite Application

Whom it May Concern Respite Application To: Subject: Whom it May Concern Respite Application Enclosed please find an application for Respite Services. Please be sure to complete the following forms: The Arc Northern Chesapeake Region application

More information

Military Subsidy Programs ELIGIBILITY APPLICATION To receive a $25 credit, complete this application online.

Military Subsidy Programs ELIGIBILITY APPLICATION To receive a $25 credit, complete this application online. Military Subsidy Programs ELIGIBILITY APPLICATION To receive a $25 credit, complete this application online. www.naccrra.org/militaryprograms Military Subsidy Department 1515 N. Courthouse Rd, 11 th flr

More information

Once the application and all of the required information has been gathered, send the documents and the application to the Bloomington SCCAP office.

Once the application and all of the required information has been gathered, send the documents and the application to the Bloomington SCCAP office. Dear Energy Assistance Applicant, Enclosed you will find your application for the 2012-2013 Energy Assistance Winter Program. Please read through all of the information included inside this packet. We

More information

O P E R A T I O N S M A N U A L

O P E R A T I O N S M A N U A L Charity Care Policy PRI020101FIS.C02 Page 1 of 8 O P E R A T I O N S M A N U A L SUBJECT: Charity Care Policy INSTITUTION: MID COAST HOSPITAL Supersedes: 3/99, 4/01, 3/02, 2/04 (PRI44FIS.C02), 5/05, 3/06,

More information

Palmyra 1703 Marion City Road Hannibal Palmyra, Missouri

Palmyra 1703 Marion City Road Hannibal Palmyra, Missouri Palmyra 1703 Marion City Road Hannibal 573-769-2077 Palmyra, Missouri 63461 573-221-0678 Application for Employment Mr. Date: Name: Mrs. Miss. Maiden Name: (last) (first) (middle) Address: (house number

More information

YMCA of Brandon Summer Camp Assistance Application

YMCA of Brandon Summer Camp Assistance Application Application Deadline: April 6 th, 2018 The YMCA believes that every kid deserves a chance to experience a YMCA Summer Camp regardless of ability to pay. Our Financial Assistance Program was developed to

More information

Delta Sigma Theta Sorority, Incorporated Crimson and Cream and STEM Scholarship Application

Delta Sigma Theta Sorority, Incorporated Crimson and Cream and STEM Scholarship Application Delta Sigma Theta Sorority, Incorporated Chesterfield Alumnae Chapter 2017 Crimson and Cream and STEM Scholarship Application Applications must be postmarked and returned via mail to: Scholarship Committee

More information

Middletown Summer Youth Employment Program. Summer 2018

Middletown Summer Youth Employment Program. Summer 2018 Middletown Summer Youth Employment Program Summer 2018 Summer 2018-Youth @ Work Middletown Summer Youth Employment Program IMPORTANT PROGRAM NOTES Applications will be available on Monday, April 2, 2018

More information

HOME ENERGY ASSISTANCE/UNIVERSAL SERVICE FUND (USF) AND WEATHERIZATION PROGRAM APPLICATION

HOME ENERGY ASSISTANCE/UNIVERSAL SERVICE FUND (USF) AND WEATHERIZATION PROGRAM APPLICATION Applicant Address HOME ENERGY ASSISTANCE/UNIVERSAL SERVICE FUND (USF) AND WEATHERIZATION PROGRAM APPLICATION Last Name 01 First Name 02 MI 03 _ Application Date: / / 10 Mailing address Street Address 04

More information

CATHERINE FUND FINANCIAL AID APPLICATION March 2016

CATHERINE FUND FINANCIAL AID APPLICATION March 2016 GUIDELINES/ QUALIFICATIONS FOR Please read all Guidelines, Policies and Procedures, and Instructions before completing application. You must meet all guidelines for your application to be considered. 1.

More information

Summer YouthWorks Employment Program 2012

Summer YouthWorks Employment Program 2012 Summer YouthWorks Employment Program 2012 YOU MUST VISIT: www.massyouthemployment.org and create a Youth account by clicking on Apply for a Youth Job prior to submitting a SYEP application APPLICANTS MUST

More information

LUCILLE AND LESTER KORSMEYER 4-H SCHOLARSHIP

LUCILLE AND LESTER KORSMEYER 4-H SCHOLARSHIP APPLICATION GUIDELINES Application deadline is April 12, 2018. THE SCHOLARSHIP An annual scholarship in the amount of $1,000 will be awarded to one student for up to four years of continued education at

More information

THE LILLY ENDOWMENT COMMUNITY SCHOLARSHIP

THE LILLY ENDOWMENT COMMUNITY SCHOLARSHIP THE LILLY ENDOWMENT COMMUNITY SCHOLARSHIP Administered through The Whitley County Community Foundation Application Form Any relative (including stepchildren) of the staff, trustees or scholarship committee

More information

GREENWOOD LEFLORE HOSPITAL FINANCIAL ASSISTANCE POLICY

GREENWOOD LEFLORE HOSPITAL FINANCIAL ASSISTANCE POLICY GREENWOOD LEFLORE HOSPITAL FINANCIAL ASSISTANCE POLICY Scope: This Greenwood Leflore Hospital ( Hospital ) Financial Assistance Policy ( FAP ) applies to all charges for emergency and medically necessary

More information

Illinois Resident Application for Financial Assistance. Information You Should Know

Illinois Resident Application for Financial Assistance. Information You Should Know Illinois Resident Application for Financial Assistance Information You Should Know Important: YOU MAY BE ABLE TO RECEIVE FREE OR DISCOUNTED CARE: Completing this application will help Cook County Health

More information

Employment, Training, and Support Services Application

Employment, Training, and Support Services Application Employment, Training, and Support Services Application PHYSICAL LOCATION: MAILING ADDRESS: 194 ALIMAQ DRIVE 3449 REZANOF DRIVE EAST KODIAK AK 99615 PHONE: (907) 486-9879 FAX: (907) 486-4829 EMAIL: ETSS@KODIAKHEALTHCARE.ORG

More information

NORTHWEST FLORIDA BEACHES INTERNATIONAL AIRPORT 6300 WEST BAY PARKWAY, BOX A PANAMA CITY, FL

NORTHWEST FLORIDA BEACHES INTERNATIONAL AIRPORT 6300 WEST BAY PARKWAY, BOX A PANAMA CITY, FL NORTHWEST FLORIDA BEACHES INTERNATIONAL AIRPORT 6300 WEST BAY PARKWAY, BOX A PANAMA CITY, FL 32409 850-636-8950 APPLICATION FOR EMPLOYMENT (An Equal Opportunity Employer and Drug-Free Workplace) All applicants

More information

Sussex YMCA Hardyston Before & After School Program Registration Form 2015-2016 School Year Please return this completed form to the Sussex YMCA to register for the School Age Child Care Program for the

More information

PLAY Application Checklist

PLAY Application Checklist PLAY Application Checklist Use the following checklist to ensure you complete all steps before you submit your application. Incomplete applications cannot be accepted. Applicant Are You a Denver Resident?

More information

YOU MUST FULLY COMPLETE THE APPLICATION AND SUBMIT ALL REQUIRED CERTIFICATIONS STATED IN THE APPLICATION PROCESS.

YOU MUST FULLY COMPLETE THE APPLICATION AND SUBMIT ALL REQUIRED CERTIFICATIONS STATED IN THE APPLICATION PROCESS. FORT MYERS BEACH FIRE DEPARTMENT APPLICATION FOR EMPLOYMENT SUBMIT FORM (PLEASE PRINT CLEARLY) DATE: 20 YOU MUST FULLY COMPLETE THE APPLICATION AND SUBMIT ALL REQUIRED CERTIFICATIONS STATED IN THE APPLICATION

More information

1414 Kuhl Ave. Orlando, Florida Michele T. Napier, Chief Revenue Officer. Board

1414 Kuhl Ave. Orlando, Florida Michele T. Napier, Chief Revenue Officer. Board Page: 1 of 10 Developed By: I. POLICY: It is the policy of Orlando Health to establish Financial Assistance processes that assume proportionate responsibility in order to provide health care services to

More information

Neighborhood Services 900 W. Gentry Parkway Tyler, Tx Office (903) Fax (903) FAMILY SELF SUFFICIENCY ASSESSMENT QUESTIONNAIRE

Neighborhood Services 900 W. Gentry Parkway Tyler, Tx Office (903) Fax (903) FAMILY SELF SUFFICIENCY ASSESSMENT QUESTIONNAIRE 1 Neighborhood Services 900 W. Gentry Parkway Tyler, Tx. 75702 Office (903)531-1303 Fax (903)531-1333 FAMILY SELF SUFFICIENCY ASSESSMENT QUESTIONNAIRE CITY OF TYLER HOUSING AGENCY DATE: / / A. DEMOGRAPHIC

More information

12 King Philip Rd. Sudbury, MA (585)

12 King Philip Rd. Sudbury, MA (585) Dear Parents, In order to get started with speech therapy services including screening, evaluation, and treatment, we ask that you submit the following registration paperwork to Sudbury Speech and Language

More information

FINANCIAL ASSISTANCE POLICY

FINANCIAL ASSISTANCE POLICY TITLE: FINANCIAL ASSISTANCE POLICY STATEMENT OF PURPOSE: This policy is intended to establish guidelines for a structured procedure so as not to exclude anyone from seeking medical services on the grounds

More information

APPLICATION FOR BURBANK SISTER CITY 2018 STUDENT EXCHANGE PROGRAM TO OTA, JAPAN

APPLICATION FOR BURBANK SISTER CITY 2018 STUDENT EXCHANGE PROGRAM TO OTA, JAPAN APPLICATION FOR BURBANK SISTER CITY 2018 STUDENT EXCHANGE PROGRAM TO OTA, JAPAN The cities of Ota, Japan and Burbank, California have successfully participated in a 2-week summer cultural student exchange

More information

APPLICATION FOR BENEFITS LAW ENFORCEMENT OFFICERS AND FIRE FIGHTERS DISABILITY BENEFITS TRUST FUND

APPLICATION FOR BENEFITS LAW ENFORCEMENT OFFICERS AND FIRE FIGHTERS DISABILITY BENEFITS TRUST FUND EXHIBIT A M S Attorney General s Office Use Only: Application #: Receipt Date: G Approved G Disapproved Claim type: G Law Enforcement Officer G Fire Fighter STOP. Please read the fund policies and procedures

More information

DIOCESE OF SAN JOSE SCHOOL ADMINISTRATION APPLICATION FORM

DIOCESE OF SAN JOSE SCHOOL ADMINISTRATION APPLICATION FORM DIOCESE OF SAN JOSE SCHOOL ADMINISTRATION APPLICATION FORM PERSONAL INFORMATION LEGAL NAME Last First M.I. ADDRESS Street City State Zip CONTACT Daytime Phone Cell Phone Email Address RELIGION Faith Parish/Church

More information

Loxahatchee River District. Employment Application. Applicant Information. Employment Positions

Loxahatchee River District. Employment Application. Applicant Information. Employment Positions Loxahatchee River District Employment Application An Equal Opportunity Employer The District is an equal opportunity employer. This application will not be used for limiting or excluding any applicant

More information

National Association for the Advancement of Colored People (NAACP) Duplin County Branch (Unit # 5385/Youth # 5887)

National Association for the Advancement of Colored People (NAACP) Duplin County Branch (Unit # 5385/Youth # 5887) DUPLIN COUNTY NAACP SCHOLARSHIP PACKAGE (2018) Complete application package should be in the hands of a scholarship committee member by 5:00 p.m. on Monday, April 23, 2018. This does not mean in the mail

More information

Rehabilitation Grant Program (RGP) Information & Application

Rehabilitation Grant Program (RGP) Information & Application Objective: Rehabilitation Grant Program (RGP) Information & Application Clearfield City has established the Rehabilitation Grant Program (RGP) to provide assistance for home improvements that eliminate

More information

Junior Volunteer 2018 Summer Program Application (This is a 9 week program starting June 11 th and ending August 10 th )

Junior Volunteer 2018 Summer Program Application (This is a 9 week program starting June 11 th and ending August 10 th ) The following information will help us become better acquainted with you. We are especially interested in your qualifications and interest as a prospective volunteer. PLEASE PRINT. Please return this completed

More information

Grand Prairie Fire Department Applicant Identification Form

Grand Prairie Fire Department Applicant Identification Form Revised 07/15 Grand Prairie Fire Department Applicant Identification Form Place Picture Name: Last First Middle DOB: Weight: Height: Hair Color: Eye Color: Social Security No.: D.L. #: Complete the areas

More information

Candidates failing to include ALL required documentation will be disqualified.

Candidates failing to include ALL required documentation will be disqualified. To All Police Officer Candidates: Thank you for your interest in employment with the City of South St. Paul! We anticipate hiring two officers immediately with additional opening(s) occurring during the

More information

THE LILLY ENDOWMENT COMMUNITY SCHOLARSHIP Administered through The Whitley County Community Foundation Application Form

THE LILLY ENDOWMENT COMMUNITY SCHOLARSHIP Administered through The Whitley County Community Foundation Application Form THE LILLY ENDOWMENT COMMUNITY SCHOLARSHIP Administered through The Whitley County Community Foundation Application Form Any relative (including stepchildren) of the staff, trustees or scholarship committee

More information

New for the 2019 ADEA AADSAS Fee Assistance Program!

New for the 2019 ADEA AADSAS Fee Assistance Program! 2019 ADEA AADSAS Fee Assistance Program Instructions Welcome to the 2019 ADEA AADSAS Fee Assistance Program (ADEA AADSAS FAP). ADEA AADSAS FAP is a fee assistance program designed to assist students who

More information

Financial Assistance Policy

Financial Assistance Policy Financial Assistance Policy POLICY TITLE: Financial Assistance Policy LAST REVISION/REVIEW DATE: July 1, 2018 PREVIOUS UPDATE: May 10,2018 DATE OF ORIGIN: April 1, 2007 Policy: Christiana Care is dedicated

More information

Instructions for Form I-2o

Instructions for Form I-2o Instructions for Form I-2o Please read all instructions carefully before submitting the Application for Form I-20. If you submit the Application for Form I-20 without following all instructions, your Form

More information

Wayzata Fire Department 600 East Rice Street Wayzata, Minnesota (952)

Wayzata Fire Department 600 East Rice Street Wayzata, Minnesota (952) Wayzata Fire Department 600 East Rice Street Wayzata, Minnesota 55391 (952) 404-5337 Dear Prospective Applicant, Thank you for inquiring about joining our Fire Department. We appreciate your interest in

More information

Fannin County Children s Center Volunteer Application

Fannin County Children s Center Volunteer Application Fannin County Children s Center Volunteer Application Name: Address (Street Address / City / State / Zip): Telephone: Home: ( ) Cell: ( ) Work: ( ) If employed: May you be called at work? YES NO Email

More information

BRIDGES 21 st Century Community Learning Center

BRIDGES 21 st Century Community Learning Center 78 Betsy Ross Lane Sylacauga, AL 35150 (256)245-4343 BRIDGES 21 st Century Community Learning Center Application Packet BRIDGES Registration Date: Free Lunch?: Yes No OR Reduced Lunch?: Yes No Have you

More information

Assumption of the BVM/Immaculate Conception Family Faith Formation Tuition Rates & Information

Assumption of the BVM/Immaculate Conception Family Faith Formation Tuition Rates & Information Assumption of the BVM/Immaculate Conception Family Faith Formation Tuition Rates & Information 2017 2018 Family Name: IMPORTANT: Please provide your current e-mail address, as this is our method of communicating

More information

Child Care Assistance Program Teacher Leader Summit May 2018

Child Care Assistance Program Teacher Leader Summit May 2018 Child Care Assistance Program Teacher Leader Summit May 2018 Agenda The objective of this training is to provide our community partners, CCAP providers, stakeholders, and lead agencies with current and

More information

Application Deadline: Tuesday, April 25, 2017

Application Deadline: Tuesday, April 25, 2017 Career and Technical Education (CTE) Summer Youth Internship Program We are proud to announce the Summer Youth Internship program co-sponsored by the City of Fayetteville, the Public Works Commission (PWC)

More information

Creating Futures (WIOA young adult)

Creating Futures (WIOA young adult) Creating Futures (WIOA young adult) Serving Linn, Johnson, Jones, Benton, Iowa, Washington, and Cedar Counties Applicant Information Full Name: _ (Last) (First) (Middle) (Maiden) Address: _ (Street) (City)

More information

INTERNATIONAL STUDENT CERTIFICATION OF FINANCES

INTERNATIONAL STUDENT CERTIFICATION OF FINANCES INTERNATIONAL STUDENT CERTIFICATION OF FINANCES 2018-19 The purpose of the Certification of Finances is to help colleges and universities obtain complete and accurate information about the funds available

More information

PHILLYSEEDS SCHOLARSHIP PROGRAM APPLICATION REQUIREMENTS AND CHECKLIST

PHILLYSEEDS SCHOLARSHIP PROGRAM APPLICATION REQUIREMENTS AND CHECKLIST PHILLYSEEDS SCHOLARSHIP PROGRAM APPLICATION REQUIREMENTS AND CHECKLIST ELIGIBILITY Seeking full-time admission to a two-year or four-year college, university or trade/technical school; GPA of at least

More information

Camp Extreme Scholarship Application 2018

Camp Extreme Scholarship Application 2018 Tuition for Camp Extreme 2018 is $5,000. Scholarships are provided on a first come first served basis until scholarship funds are depleted. Many worthy participants request scholarships to Project Extreme

More information

Application for Employment Related Day Care (ERDC) Program

Application for Employment Related Day Care (ERDC) Program Application for Employment Related Day Care (ERDC) Program Please read these instructions before filling out this application. Answer all questions. Do not write in the shaded areas. To contact our office

More information

Citrus County Tax Collector s Office Application for Employment

Citrus County Tax Collector s Office Application for Employment Citrus County Tax Collector s Office Application for Employment We are an equal opportunity employer and do not unlawfully discriminate in employment. No question on this application is used for the purpose

More information

Indiana Energy Assistance Program Application Part 1. Personal Information

Indiana Energy Assistance Program Application Part 1. Personal Information INSERT AGENCY LOGO 2017-2018 Indiana Energy Assistance Program Application Part 1. Personal Information Your Name Date of Birth First MI Last Social Security Number MM-DD-YYYY Current Home Address: Street

More information

Peoria Heights Fire Department. Membership Application Packet

Peoria Heights Fire Department. Membership Application Packet Peoria Heights Fire Department Membership Application Packet Please turn in all completed applications in a sealed envelope to the Village Administration office during normal business hours, or mail to

More information

St. Elizabeth Healthcare- Financial Assistance Policy

St. Elizabeth Healthcare- Financial Assistance Policy St. Elizabeth Healthcare- Financial Assistance Policy Objective Consistent with its mission to provide comprehensive and compassionate care that improves the health of the people we serve, St. Elizabeth

More information

ILLINOIS ELKS CHILDREN S CARE CORPORATION PHYSICAL OR OCCUPATIONAL THERAPY ASSISTANT APPLICATION

ILLINOIS ELKS CHILDREN S CARE CORPORATION PHYSICAL OR OCCUPATIONAL THERAPY ASSISTANT APPLICATION ILLINOIS ELKS CHILDREN S CARE CORPORATION 2018-2019 PHYSICAL OR OCCUPATIONAL THERAPY ASSISTANT APPLICATION QUALIFICATIONS, REQUIREMENTS, AND SUBMITTING APPLICATION (APPLICATION OVER VIEW) This is a COMPETITIVE

More information

Kauai Community Federal Credit Union Scholarship Program

Kauai Community Federal Credit Union Scholarship Program Kauai Community Federal Credit Union Scholarship Program At KCFCU we strongly endorse the pursuit of higher education. That is why, we offer up to ten (10) $1000 scholarships to graduating high school

More information

Parent and Student Handbook. Scholarship Program

Parent and Student Handbook. Scholarship Program Parent and Student Handbook Scholarship Program American Association of Blacks in Energy 1625 K Street, NW, Suite 405, Washington, DC 20006 202-371-9530 * info@aabe.org * www.aabe.org Table of Contents

More information

TEEN VOLUNTEER APPLICATION (AGES 16-17)

TEEN VOLUNTEER APPLICATION (AGES 16-17) TEEN VOLUNTEER APPLICATION (AGES 16-17) APPLICATION MUST BE FILLED OUT BY THE INDIVIDIAL APPLYING FOR THE VOLUNTEER POSITION. Completed applications can be returned to Lake Wales Medical Center Dir. Volunteer

More information

Achieving Dreams Scholarship

Achieving Dreams Scholarship Achieving Dreams Scholarship The Migrant Network Coalition is a broad-based coalition of public and private organizations and individuals. Since 1994, we have been collaborating to meet the needs of our

More information

Cynthia H Kuo Scholarship

Cynthia H Kuo Scholarship Cynthia H Kuo Scholarship Administered by Silicon Valley Community Foundation Scholarship Amount: up to $5000 Number of Awards: Up to 5 Background: The Cynthia H. Kuo scholarship fund was established in

More information

Application for Admission Nurse Aide Training Program

Application for Admission Nurse Aide Training Program Med-Cert Training Center Maple Heights Med-Cert Training Center AKRON 5416 Northfield Road 771 North Main Street Maple Heights, OH 44137 Akron, OH 44310 Phone (440) 786-2378, Fax (440) 786-7327 1-877-514-2378

More information

2016 Counselor In Training Program Application

2016 Counselor In Training Program Application Town of Poughkeepsie Recreation Department 1 Overocker Road Phone (845) 485-3628 Poughkeepsie, NY 12603 Fax (845) 485-3616 2016 Counselor In Training Program Application Thank you for your interest in

More information

Guide to Acceptable Documentation for the National Verifier. National Verifier Acceptable Documentation Guidelines

Guide to Acceptable Documentation for the National Verifier. National Verifier Acceptable Documentation Guidelines Guide to Acceptable Documentation for the National Verifier National Verifier Acceptable TABLE OF CONTENTS Overview... 3 Proof of Eligibility... 3 Minimal criteria for acceptance... 3 Proof of Eligibility

More information

The following definitions apply to such eligibility criteria:

The following definitions apply to such eligibility criteria: PURPOSE The purpose of this policy is to define the charitable mission of Upland Hills Health Inc. (the "Hospital"), providing financially disadvantaged and other qualified patients with an avenue to apply

More information

PLEASE TYPE OR PRINT CLEARLY USING A PEN. Today s Date:

PLEASE TYPE OR PRINT CLEARLY USING A PEN. Today s Date: Name: Previous Name/s: Home Phone No: Work Phone No: E-mail: What class of Administrative Certificate do you hold? PLEASE TYPE OR PRINT CLEARLY USING A PEN Today s Date: If you do not possess an administrative

More information

SUNNY BLEICH COMPLETION BURSARY FOR UNDERGRADUATE STUDENTS

SUNNY BLEICH COMPLETION BURSARY FOR UNDERGRADUATE STUDENTS SUNNY BLEICH COMPLETION BURSARY FOR UNDERGRADUATE STUDENTS Donor: Robin Bleich Value: $820 Tuition Credit Number: One (1) Description of the Award The Sunny Bleich Completion Bursary for Undergraduate

More information

American Association of Blacks in Energy 2018 Scholarship Guidelines and Application

American Association of Blacks in Energy 2018 Scholarship Guidelines and Application American Association of Blacks in Energy 2018 Scholarship Guidelines and Application South Carolina Chapter Josie K. Claiborne Memorial Scholarship Post Office Box 7696 Columbia, SC 29202 Website: http://www.aabe.org/southcarolina

More information

CAMP AT THE EASTWARD A Youth Ministry of Mission at the Eastward

CAMP AT THE EASTWARD A Youth Ministry of Mission at the Eastward CAMP AT THE EASTWARD A Youth Ministry of Mission at the Eastward Dear Camper and Family, We are welcoming some changes to the camp schedule this year! In an effort to allow our dedicated work groups to

More information

All applications should be signed and dated in all designated areas of these forms.

All applications should be signed and dated in all designated areas of these forms. 2666 Riva Rd., Suite 400 Annapolis, MD 21401 Phone (410)-222-4464 TTY Users call via MD Relay 711 exjord00@aacounty.org Pamela A. Jordan Director July 1, 2017 Dear Applicant: Enclosed is an application

More information

SACRED HEART PARISH LA GRANGE, TEXAS

SACRED HEART PARISH LA GRANGE, TEXAS SACRED HEART PARISH LA GRANGE, TEXAS DIOCESE OF AUSTIN ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

More information

PLEASE READ COMPLETELY BEFORE FILLING OUT THE APPLICATION

PLEASE READ COMPLETELY BEFORE FILLING OUT THE APPLICATION ERIE COUNTY COMMUNITY FOUNDATION BUCKEYE BROADBAND BCSN SCHOLARSHIP PROJECT FUND SCHOLAR OF THE MONTH 2018-2019 INFORMATION SHEET PLEASE READ COMPLETELY BEFORE FILLING OUT THE APPLICATION PURPOSE To provide

More information

PERSONAL ASSISTANCE SERVICES PROGRAM APPLICATION FOR SERVICE AND STATEMENT OF UNDERSTANDING. Applicant Name County Sussex

PERSONAL ASSISTANCE SERVICES PROGRAM APPLICATION FOR SERVICE AND STATEMENT OF UNDERSTANDING. Applicant Name County Sussex APPLICATION FOR SERVICE AND STATEMENT OF UNDERSTANDING Applicant Name County Sussex Address Social Security# I hereby apply for participation in the Personal Assistance Program. I agree to the following

More information

Westport Weston Family YMCA 2018 Financial Assistance Application

Westport Weston Family YMCA 2018 Financial Assistance Application Westport Weston Family YMCA 2018 Financial Assistance Application Thank you for applying for Financial Assistance to the Westport Weston Family YMCA. Please note that we review all applications very carefully,

More information

Please mark your interests above and return to the YMCA Welcome Center

Please mark your interests above and return to the YMCA Welcome Center Volunteerism is the willingness to help others without the expectation of pay or tangible benefit. Are you most interested in: Fulfilling a school or work requirement, if so, how many hours _ Fulfilling

More information

SUBCHAPTER 11. CHARITY CARE

SUBCHAPTER 11. CHARITY CARE SUBCHAPTER 11. CHARITY CARE 10:52-11.1 Charity care audit functions 10:52-11.2 Sampling methodology 10:52-11.3 Charity care write off amount 10:52-11.4 Differing documentation requirements if patient admitted

More information

Please return your completed application to

Please return your completed application to Dear Potential Volunteer, Thank you for your interest in volunteering with Charlotte Pediatric Clinic. Volunteers are an important part of our team and help us in many ways. We appreciate everyone who

More information

Youth Expanded Studies Program. Educational Assistance Program of the Community Foundation of Sarasota County ********** Application Form

Youth Expanded Studies Program. Educational Assistance Program of the Community Foundation of Sarasota County ********** Application Form Youth Expanded Studies Program Educational Assistance Program of the Community Foundation of Sarasota County ********** Application Form 01/2018 COMMUNITY FOUNDATION OF SARASOTA COUNTY The Community Foundation

More information

2017 SCHOLARSHIP AWARD APPLICATION

2017 SCHOLARSHIP AWARD APPLICATION 2017 SCHOLARSHIP AWARD APPLICATION Must be submitted and received by February 1, 2017 Our Mission The Elliott-Chandler Foundation supports the development of leaders of tomorrow by providing financial

More information

Application Guidelines

Application Guidelines Harlem YMCA Black Achievers in Industry Youth Achiever Scholarship Application Guidelines Eligibility All African-American NYC college bound high school seniors that participate in NYC YMCA teen programs.

More information