Request for Financial Assistance
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Girls on the Run of NOVA is committed to ensuring our program is available to every girl. If you are in need of financial assistance but do not qualify based on eligibility requirements listed below, please fill out this request form for consideration of a reduced fee.

 To make the program accessible to all families, we offer have several financial assistance and payment options.

          -A registration fee of $75 for those who qualify for reduced lunch program;
          -A registration fee of $22 for those who qualify for free lunch program;
          -A registration fee of $22 for those who qualify for SNAP, TANF, WIC, or Medicaid or any other public financial assistance;
          -Payment plan options, dividing payments into either two or three spaced out payments (this option is open to all families).

If you are not eligible for financial assistance using the above listed criteria and would like to submit a request for financial assistance, please fill out the form below.  A Girls on the Run of NOVA staff member will be in touch about your registration within two (2) business days.


**Please note: If you DO qualify based on the list above please return to the program registration page at https://www.pinwheel.us/register/index/PROGRAMREGSP24 to complete the registration process and select the applicable financial assistance option when prompted.
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Parent/Guardian First and Last Name *
E-mail Address *
Phone Number *
 Girl’s Name *
 Girls on the Run Site/Location Name *
What is your annual household income? *
    How many children are in your household? *
Do any of the following apply to you (select all that apply)? *
Please provide any additional details that we should consider when considering your request?
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