scholarship form Applicant Information Name (required) Address City, State, and Zip Phone Email Marital StatusSingle Married Divorced Separated Widowed Housing StatusHomeowner Renter Living with Family/Friends Other Please complete all information of all individuals in househols, including spouse/partner Depentant's First and Last Name Date of Birth Relationship Program applying for . Depentant's First and Last Name Date of Birth Relationship Program applying for . Depentant's First and Last Name Date of Birth Relationship Program applying for . Depentant's First and Last Name Date of Birth Relationship Program applying for . Depentant's First and Last Name Date of Birth Relationship Program applying for . Depentant's First and Last Name Date of Birth Relationship Program applying for . Depentant's First and Last Name Date of Birth Date of Birth Program applying for Employment Information Applicant's Employer Address Phone Spouse's Employer/Second Employer Address Phone Of not employed, how long have been unemployed? Scholarship Application Do you have or recieve any of the following? FOOD STAMPS/EBT/CAL FRESHYes No SOCIAL SECURITY/ DISABILITYYes No UNEMPLOYMENT BENEFITSYes No CHILD SUPPORTYes No SAVINGS/INVESTMENT ACCOUNTSYes No HOUSING SUBSIDATIONYes No CAL WORKS/CASH AIDYes No Please list all other sources of income received by all household members. (Before deductions) Household Member Name of Agency or Place of Employment Address/Phone of Agency or Employer Amount per Month Eligibility Applicants must be a district resident and must be under 18 years of age. Participants must provide one of the following for proof of eligibility: • Proof that participant is eligible for the Free or Reduced School Lunch Program • Proof that sibling is eligible for the Free or Reduced School Lunch Program (if participant is too young to attend school. • Proof that family is eligible to receive assistance from the Department of Human Services • Proof that family is eligible for food stamps • Proof that family is eligible for Medi-Cal or Kern Family Health Care services • Proof that family is eligible for WIC benefit The scholarship program is available to Tehachapi Valley Recreation and Park District residents. Scholarships will be awarded to applicants in accordance to scholarship criteria. Approved applicants will receive a scholarship for program registration up to $50 per person, per season (Winter, Spring, Summer, Fall). Any additional program fees above the awarded scholarship amount are due at the time of registration. All registration policies and procedures apply to scholarship applicants. Upon completion of the application, Tehachapi Valley Recreation and Park District will notify the applicant by mail within two weeks of their scholarship status. All information submitted must be true and accurate. Financial assistance awarded on the basis of false information supplied by the applicant will be revoked. Scholarships are good for one year from date of approval. All requests for scholarships must be received within a minimum of three weeks prior to the start of any requested program or activity. Remaining scholarship money awarded for one season does not carry over to the next season. Future funds cannot be used for current programs. Qualifying individuals cannot transfer their scholarship to another qualifying individual. Applications are available at the Tehachapi Valley Recreation and Park District office or online at www.tvrpd.org . Guidelines Guidelines Guidelines The scholarship program is available to Tehachapi Valley Recreation and Park District residents. Scholarships will be awarded to applicants in accordance to scholarship criteria. Approved applicants will receive a scholarship for program registration up to $50 per person, per season (Winter, Spring, Summer, Fall). Any additional program fees above the awarded scholarship amount are due at the time of registration. All registration policies and procedures apply to scholarship applicants. Upon completion of the application, Tehachapi Valley Recreation and Park District will notify the applicant by mail within two weeks of their scholarship status. All information submitted must be true and accurate. Financial assistance awarded on the basis of false information supplied by the applicant will be revoked. Scholarships are good for one year from date of approval. All requests for scholarships must be received within a minimum of three weeks prior to the start of any requested program or activity. Remaining scholarship money awarded for one season does not carry over to the next season. Future funds cannot be used for current programs. Qualifying individuals cannot transfer their scholarship to another qualifying individual. Applications are available at the Tehachapi Valley Recreation and Park District office or online at www.tvrpd.org . The scholarship program is available to Tehachapi Valley Recreation and Park District residents. Scholarships will be awarded to applicants in accordance to scholarship criteria. Approved applicants will receive a scholarship for program registration up to $50 per person, per season (Winter, Spring, Summer, Fall). Any additional program fees above the awarded scholarship amount are due at the time of registration. All registration policies and procedures apply to scholarship applicants. Upon completion of the application, Tehachapi Valley Recreation and Park District will notify the applicant by mail within two weeks of their scholarship status. All information submitted must be true and accurate. Financial assistance awarded on the basis of false information supplied by the applicant will be revoked. Scholarships are good for one year from date of approval. All requests for scholarships must be received within a minimum of three weeks prior to the start of any requested program or activity. Remaining scholarship money awarded for one season does not carry over to the next season. Future funds cannot be used for current programs. Qualifying individuals cannot transfer their scholarship to another qualifying individual. Applications are available at the Tehachapi Valley Recreation and Park District office or online at tvrpd.org Acknowledgement of Application Policy Acknowledgement of Application Policy I certify that all of the above information is true and accurate and that all income has been reported. I understand that Tehachapi Valley Recreation and Park District officials may verify this information and that misrepresentation of the information will result in denial of the scholarship. I certify that all of the above information is true and accurate and that all income has been reported. I understand that Tehachapi Valley Recreation and Park District officials may verify this information and that misrepresentation of the information will result in denial of the scholarship. Full Name Name Your Signature (required) Confirm e-Signature Review Electronic Records and Signatures Policy (required)Read our Electronic Record and Signature Disclosure I agree to use electronic records and signatures Your Signature (required) Confirm e-Signature Review Electronic Records and Signatures Policy (required)Read our Electronic Record and Signature Disclosure I agree to use electronic records and signatures Date Date There was a problem saving your submission. Please try again later. Please wait while your submission is being saved... Submitting...Submit Thank you, your submission has been received.
