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Confidential Scholarship Application

Participant Information
Household Information

Does anyone living in your household receive income from any of the following?
(check all that apply and specify amount)

Does anyone in your household participate in the Free or Reduced Price School Lunch Program? *
Do you regularly experience (or have you recently experienced) any unusual medical expenses? *
Program Information
The dates by which I can make payments are:
Additional payment dates may be arranged to meet your needs.
Authorization

I have read and understand the Scholarship Policies.

I understand that all information given is not a matter of public record and all information will be kept confidential.

I will make SSSRA aware of any changes in our financial status. All of the information I have provided is accurate.

The SSSRA Scholarship Policy is as follows:
  • Scholarships are for residents with disabilities only.
  • Deposit is required for scholarships.
  • Scholarships are based on need and the availability of funds.
  • Scholarships are usually awarded for a maximum of two programs per season.
  • The maximum scholarship award is 50% of the fee for each program. The amount of the award may be less than 50% of the fee.
  • No scholarships are awarded for Summer Day Camp Transportation, unless stated otherwise in the summer brochure.
  • All balances are due by the registration deadline of the following season.

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