Girls Inc. After School Scholarship Application
Once form is completed, please be sure to email or bring in a copy of a W-2, paystub, etc. to lmanning@girlsinctnv.org
Sign in to Google to save your progress. Learn more
IMPORTANT!
Scholarships are on a first come first serve basis. In order to be considered for a Girls Inc Scholarship for our afterschool program the application must be complete AND you must turn in a copy of a W-2, paystub, etc. Proper documentation not being turned in will result in not being qualified for the scholarship. Please email lmanning@girlsinctnv.org a copy of documentation after you have submitted the scholarship application. 
Child Full Name: *
Child's Date of Birth:  *
Parent/Guardian Information: 
Name: *
Primary Phone:  *
Address:  *
Employer/Job title:  *
Additional Parent/Guardian Information: 
Name:
Primary Phone: 
Address: 
Employer/Job Title:
Child Lives with: 
How many children live in the home? 
Applying for: 
Clear selection
Family income: (All sources of household income must be noted on the application. Must show valid proof with one of the following: last two pay stubs or W2, Unemployment stub, or Disability papers.) 
Clear selection
Are you currently receiving food stamps? (If yes, please provide case number in the "other" option box.)
Are you currently receiving Families First/TennCare?  (If yes, please provide case number in the "other" option box.)
Is your child receiving Free Lunch Program?  (If yes, please provide case number in the "other" option box.)
If not applying for full scholarship, how much money could you afford to pay per week for After School Program?  *
Why do you feel your child would benefit from Girls Inc After School Program?  *
Have you given volunteer time to Girls Inc?  *
Are your new membership dues current? (New membership begins in August of each year)  *
ATTENDANCE POLICY 
An attendance policy is now effect. Scholarship girls must attend Girls Inc. on a regular basis. Girls Inc will require notice if your child absent for 3 days in a row. 
Are there any circumstances of which Girls Inc should be aware of? If so, please explain: 
I understand all questions and statements. I certify that all of the answers given by me to the above questions are, to the best of my knowledge, true and accurate and no pertinent information has been withheld. I understand any false answer or misrepresentation by me on this application will result in my child being disqualified from consideration for a scholarship with Girls Inc and/or dismissal from the scholarship program my child is currently attending at Girls Inc. 
Girls Inc of Tennessee Valley is happy to provide scholarship opportunities for girls within the community. Our scholarship program supports about 40% of our participants. We understand that finding affordable and interactive care for your child can be difficult and Girls Inc seeks to meet those needs through our scholarship program. Unfortunately, in being a small program we also heavily rely on program fees and dues to maintain our our programming. With that being said, we ask that you understand the scholarship process and understand that the program cannot accommodate all scholarship applications received. 
 *
I understand that scholarships are on a first come first serve basis and in order to qualify for scholarship I must turn in a W-2, paystub, tax form, etc. for my application to be considered. 
Clear selection
PLEASE NOTE: 
1. Full scholarships are only available for one of the programs listed above. If you have already received a full scholarship for another program, you may apply, but first time applicants will receive higher priority. 
2. Scholarships are determined on an as needed basis. Those with the highest need will receive highest priority. 
3. All necessary paperwork needs to be submitted together; late paperwork will not be accepted. 
4. Those who have been approved for Financial Assistance will receive notice 1 week before the program begins. 
REMINDER
Please email or bring in a copy of a W-2, paystub, etc. once you have completed this form. You can email any documentation to lmanning@girlsinctnv.org
Thank you for your interest in Girls Inc. of the Tennessee Valley! 
If you have any questions regarding our scholarship program, please contact Landy Manning.
(865)482-4475
lmanning@girlsinctnv.org
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Girls Inc of Tennessee Valley.

Does this form look suspicious? Report

Google Forms