NHDI 2024 Summer Intensive Financial Assistance Application

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I understand that all the information that I provide on this Financial Assistance Application will be handled with confidentiality.

I verify that all of the above information is accurate to the best of my knowledge. I give the staff of NHDI the permission to verify/confirm my information with my child's school administration, if necessary.

I understand that all financial assistance provided by NHDI is awarded without regard to sex, race, religion, national origin or sexual preference.

Email *

Your Name *

Your Email Address *

Your Child's Name *

Your Child's School *

Your Child's Grade *

Does anyone in your household participate in the following assistance programs? (choose all that apply) *

SNAP (Supplemental Nutritiion Assistance Program)

TANF (Temporary Assistance for Needy Families)

WIC (Women, Infants and Children)

None of the above.

Required

Has your household qualified for the free or reduced price school lunch program for this school year? *

Yes

What is your total annual household income? *

How many individuals (adults and children) live in your household? *

Please explain your current special circumstances that the Financial Assistance Committee should be aware of as they review your application. *

A copy of your responses will be emailed to the address you provided.

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