Youth Scholarship Application What program are you applying for? Total cost of program. * $ Amount of scholarship requested from WIA. * WIA does not provide scholarships for the total program cost. $ Would you accept a partial scholarship of your requested amount? * If you select no, and WIA is not able to provide the full amount of your request, you will not be issued an award. Yes No Please indicate the amount of financial assistance you are requesting from other sources. * $ How many adults live in your household? * How many children live in your household? * Zip Code * Does your family live or attend school in Big Sky? * Yes No Annual pre-tax income for the household * Please give your best estimate, including both parents even if in separate households, unemployment benefits, alimony, child support, investments, rental property income, etc. $ Please give a short description of your household. * I.e. two parents in one household, parents in separate households and co-parenting, parents in separate households, one with sole custody, etc. Is there any additional information that will be helpful in determining your family's eligibility? Child's Name * First Name Last Name Child's age at start of program * Child's gender * Male Female Does your child have any special needs? * Yes No What are you hoping your child will gain from this experience? * How did you hear about WIA's scholarships? * What do WIA scholarships mean to you and your family? I give permission for my anonymous quote to be used in media releases, written information, website postings, or brochures used to promote the work of WIA. * Yes No I consent to receive email requests for photographs of the program to be used in media releases, written information, website postings, grant reports, or brochures produced to promote the work of WIA. * Yes No I understand that all of the above information is true and correct and that all income is represented. I understand that this information is being given for receipt of the WIA Financial Assistance Program and that WIA staff may verify the information on the application. I understand that deliberate misrepresentation of the information will disqualify me immediately from this program. I understand Parent Email * Parent Phone # * (###) ### #### Please enter your full name to digitally sign this application. * First Name Last Name Thank you for submitting a youth scholarship application. We will confirm your award with you and the program you applied for by early November.
