Scholarship Form 2017-06-14T05:14:28+00:00

Application for Program Scholarship




Child's Name*
Child's Date of Birth*
Gender*
School*
Grade**
Parent's/Guardian's Name**
Street Address*
City*
Zip*
Phone*
Alternate Phone
Email Address
Program Name*
Program Season*
Do you particpate in the school's free and reduced program?
I authorize the Archbold Area School District to release information regarding free/reduced lunch program participation to the Village of Archbold Department of Parks & Recreation. (Must be selected if choosing either of the lunch programs above.)
Please make applicable selections
I understand that if I qualify for the Free Lunch program that I will be required to pay for 25% of the registration fee.
I understand that if I qualify for the Reduced Lunch program that I will be required to pay for 50% of the registration fee.
I understand that my child will be eligible for two scholarships per year and that I am responsible for the registration fees for all subsequent programs this calendar year.
I understand that program scholarships are distributed on a first come first serve basis and that I am not guaranteed a scholarship for any program.
Please give a brief explanation of why you would like your child to receive a scholarship*
* I certify that the above information is true and complete to the best of my knowledge. I understand that scholarship assistance is based on need and financial need does not automatically guarantee selection.