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FAMILY Form
Grant Application
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1.
Requestor/Parent
Information
(Required.)
Your Name:
Your Email Address:
Did you apply for Free- or Reduced-Price Lunch?
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2.
Program/Activity
Information
(Required.)
Name of Provider:
Description of Program/Activity:
Start Date of Program:
Full Cost of Program:
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3.
Beneficiary/Student
Information - Child 1
(Required.)
Child's Name:
Current School:
Grade:
4.
If this application is for multiple children, please provide First & Last Name, School, and Grade for each child:
Child 2:
Child 3:
Child 4:
Child 5:
Child 6:
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5.
Have you applied for financial aid through the provider?
(Required.)
Yes
No
6.
If yes, what is the adjusted cost?
*
7.
Have you asked another group or non-profit to cover this cost?
(Required.)
Yes
No
8.
If Yes, Who did you ask and how much did you ask for?
Group name:
Amount Requested:
9.
Was your request approved?
Yes
No
10.
Amount approved?
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11.
How much can you contribute toward the cost?
(Required.)
12.
If there is any other information you would like to include with your application, please do so below:
