2020-2021 AS Financial Assistance

2020-2021 After School Financial Assistance

A registration form must be completed and space secured in the program to be considered for financial assistance.

1. Each application MUST be accompanied by a 1040 form from the most previous tax year AND a free/reduced lunch form from the school the child attends. APPLICATIONS WILL NOT BE CONSIDERED WITHOUT THESE FORMS BEING SENT TO THE GIRLS PLACE OFFICE BY August 7, 2020. You may bring the appropriate forms to the Girls Place office personally, or a copy may be faxed to (352) 373-5550.
2. Need will be assessed by administrative staff based upon the responses to the questionnaire below.
3. An application will not be considered without EVERY question being answered and the registration form submitted prior.
Financial Assistance Details
1. Receipt of assistance does not entitle a member to full assistance. In most cases, when assistance is granted, parents will be responsible for some of the fees for the program.
2. The administrative staff and the economic status of Girls Place shall determine the amount of members assisted and the level of assistance.
3. Financial assistance is good for one season/program only. If you are granted any assistance, it WILL NOT roll over to the next program your child participates in.
Personal
Parent Name*
First and Last Name
First Child's Name*
First and Last Name
Date of Birth*
Date Format: MM slash DD slash YYYY

mm/dd/yyyy
Grade in AUGUST 2020*
School in August 2020*
Second Child's Name (if applicable)
First and Last Name
Date of Birth
Date Format: MM slash DD slash YYYY

mm/dd/yyyy
Grade in AUGUST 2020
School in August 2020*
Third Child's Name (if applicable)
Date of Birth
Date Format: MM slash DD slash YYYY

mm/dd/yyyy
Grade in AUGUST 2020
School in August 2020*
Residence
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Preferred Phone*
Cell Phone
Email address checked regularly*
Number of adults (18 years old and up) living at above residence:*
Number of children (0-17 years old) living at above residence:*
Do any of the above residents have special needs?
- Yes
- No
If yes, please describe:
Finances
Amount of combined annual income for ALL adults at the above residence. This has to be verified with your 2018 1040 Form.*
Does your child qualify for the FREE or REDUCED lunch program at school?*
- Free
- Reduced
- None
- I do not know
Describe any federal, state, or local assistance the family is currently receiving (i.e. Food Stamps, Medicaid, Early Learning Coalition, etc.). Please note that a child currently receiving assistance from ELC will not be eligible for additional assistance from Girls Place.
In addition, please write a brief statement describing why you feel your family is in need of financial assistance for one of our programs. Be sure to include a description of any financial constraints above and beyond the eligibility requirements.*
By typing my full name below, I hereby agree to abide by the rules and regulations of Girls Place, Inc., as they relate to my application for financial aid:*

2020-2021 After School Financial Assistance

Financial Assistance Details

Personal

Residence

Finances