Membership Scholarship Program Instructions - Kerrville

Membership Scholarship Program Instructions - Kerrville

Membership Scholarship Program Instructions
Please read carefully and follow the step by step instructions to complete your scholarship application.
1. This packet includes the Scholarship Agreement Form and the Scholarship Application
2. Please read the Scholarship Agreement Form, sign and date at the bottom of the page.
3. Completely fill out the Scholarship Application and provide copies of all income verification as outlined
in the application.
4. Scholarship Applications are accepted according to the following schedule:
Acceptance of Application
Processing Period
Membership Term
March 1-15
March 16-30
April- March (1 yr.)
June 1-15
June 16-30
July-June (1 yr.)
September 1-15
September 16-30
October- September (1 yr.)
December 1- 15
December 16-31
January- December (1 yr.)
5. Mail the completed application, including the signed Scholarship Agreement Form, the Scholarship
Request Form and copies of all income verification to:
TSA Kroc Center
Attn: Scholarship Committee
P.O. Box 290790
Kerrville, TX 78029-0790
Or you may deliver the completed application directly
to Kroc Center Front Desk.
6. You will be notified of your scholarship opportunity by phone.
7. You have thirty days after being notified of your scholarship award to sign up for membership. After
the thirty days our offer will be considered void.
8. When you come in to sign up, the front desk staff will help you complete you membership form, accept
your payment, take your picture and issue your membership card.
Thank you! We look forward to seeing you soon!
Rev. 1/4/16
OFFICE USE ONLY
□ All pages signed
□ Proof of income attached
Staff:
Scholarship Program Agreement Form
Kroc Center Scholarship Program
The Salvation Army Kroc Center is pleased to provide a comprehensive scholarship program to help provide access to
the Center’s programs. It was Joan Kroc’s vision and expectation that all individuals have equal opportunities to grow
their natural gifts and talents. The Kroc Center is a world class facility allowing just that; an equal opportunity which
allows each person the chance to discover and develop their natural gifts. We are delighted that you are interested in
participating.
Please read carefully
1. Please complete the attached application and provide copies of proof of all income (acceptable proof: two
current pay stubs, TANF notice, child support, Social Security, SNAP letter, unemployment statements, Federal
Tax Return, etc.).
2. Submit completed application and paperwork to the address mentioned on the Instruction sheet by the
deadline for the upcoming scholarship term. Incomplete applications will be returned. Any information found
to be fraudulent will result in loss or denial of the scholarship award.
3. Completion of the application does not guarantee assistance. Scholarships will be awarded based on eligibility,
funding, timeliness, and space available.
4. All requests will be responded to by phone. Once approved, the applicant is invited to return to the Center to
complete membership enrollment within the first month of the new period (January, April, July, or October).
Award recipients that do not respond within this first month will not be eligible to use the scholarship.
5. Please be prepared to pay your initial payment at time of registration and continue to follow the payment
schedule according to membership policies. Should you lapse on your payment schedule we reserve the right to
terminate the scholarship award. Membership payments may be made in one of the following ways; automatic
monthly withdraw through your debit or credit card, checking account, or savings account.
6. Registration fees cannot be waived.
7. Scholarship recipients are expected to financially contribute toward the program. 100% scholarships will not be
awarded.
8. There is no scholarship benefit for activities that fall outside of membership (such as food at the concession or
merchandise, etc.)
9. Non- use of your Kroc Center membership may result in discontinued scholarship assistance.
10. Scholarships are valid for 12 months from approval. Re-applying will be required at the end of the membership
term. Continued scholarship approval will be dependent upon financial information and frequency of previous
attendance at the Kroc Center.
11. All scholarships are confidential. Applicants agree to refrain from discussing awards with others.
Please sign as verification of your understanding and acceptance of The Salvation Army Kroc Center scholarship
program.
Signature
Print Name
Rev. 1/4/16
Date
Scholarship Request Form
Solicitud para beca
Check Appropriate Box:
Membership Application
Program Application
Summer Camp Application
Seleccione uno de los cuadros:
Solicitud de membrecia
Solicitud de programa
Solicitud de campamento de verano
SECTION I – OTHER HOUSEHOLS MEMEBRS (OTROS MIEMBROS DE LA CASA)
List all persons living in the household with applicant. Please indicate if children are foster children. (Escriba los nobres de todas las
personas que viven en su casa. Indique si los niños que vinven con usted son adoptados).
Last Name (Apellido): __________________________________ First Name (Nombre):_____________________________________
Address (Direccion): ___________________________________________________ City (Ciudad): ___________________________
Zip Code (Codigo Postal):_____________ Home Phone (Telefono del la casa): ________________ Cell(celular): ________________
Work Phone (Trabajo)______________________ email_____________________________________________________________
License ID # (Licencia de Manejar): _________________________ SS# (Seguro Social):_____________________________________
Birthdate (Fecha de Nacimiento): ______________________________ Marital Status (EstadoCivil): S /S
M/C
D/D
O/O
SECTION II – OTHER HOUSEHOLD MEMBERS (OTROS MIEMBROS DE LA CASA)
List all persons living in household with applicant. Please indicate if children are foster children. (Escriba los nombres de todas las
personas que viven en su casa. Indique si los niños que viven con usted son adoptados).
Name
Age
Sex
Relationship to Applicant
Social Security #
Birthdate
(Nombre)
(Edad)
(Sexo)
(Relacion con el Aplicante)
(Seguro social)
(Fecha de nacimiento)
SECTION III – HOUSEHOLD FINANCES (INGRESOS FINANCIEROS DE LA CASA)
Total Household Income per month for ALL PERSONS living with applicant (Ingresos mensuales de TODAS LAS PERSONAS en la casa):$__________
Include cash payments for “odd jobs”. Mark Sources of Income/Aid (Incluya pagos en efectivo por”otros trabajos”Formas de ingreso/ayudas):
Gross Salary from your Job (Ingresos total)$________________ Occupation (Ocupacion): _________________________________________
SSI/SSA (Seguro social)$_________________________
Child Support/Alimony (Manutencion de menores)$________________________
Disability (Por desabilitacion)$_________________
TANF$_________________
SNAP benefits (Estampillas)$ ____________________
Other, please list (Otros): $_____________________________________________________________________________________________
REASON FOR REQUEST: (PLEASE LIST ANY SPECIAL CIRCUMSTANCES YOU WOULD LIKE US TO KNOW- ATTACH LETTER IF NEEDED)
RAZON DE APLICACION: (POR FAVOR INCLUYA CIRCUMSTANCIAS ESPECIALES QUE A USTED LE GUSTARIA QUE CONSIDEREMOS.
INCLUYA UNA CARTA SI ES NESECARIO)____________________________________________________________________________
____________________________________________________________________________________________________________
___________________________________________________________________________________________________________
This application and required income documentation are confidential information and will be used only for scholarship
recommendations by the Membership Supervisor. (Esta aplicacion y los documentos de ingresos requeridos son información
confidencial y solamente serán usados para la revision de becas por el supervisor de membrecía).
NOTICE - in order to promote a safe and secure environment, The Salvation Army Kroc Center has placed video cameras in various
locations. As part of our commitment to the safety of children and vulnerable persons, The Salvation Army Kroc Center reserves the
right to consult public sources to determine whether any member or guest of any member poses an unreasonable risk of harm to its
patrons, staff, or visitors. (Nota – para poder promover un ambiente seguro y confiable, El Kroc Center del Salvation Army a puesto
cámaras de seguridad en varias áreas. Como parte de nuestro compromiso para la seguridad de los niños y personas vulnerables, El
Kroc Center del Salvation Army se reserva el derecho a consultar con fuentes públicas para determinar si algún miembro o visitante
esta en riesgo de dañar sin razón alguna a sus patrones, empleados, o visitantes).
SIGNATURE (FIRMA):
DATE (FECHA):
FOR OFFICE USE ONLY (PARA USO DE LA OFICINA SOLAMENTE):
DATE RECEIVED:
RECEIVED BY: __
_______
PERCENTAGE TO BE PAID BY PARTICIPANT____________ PERCENTAGE TO BE PAID BY KROC__________APPROVED YES NO DATE________
Notes: _________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________
Rev. 1/4/16
The Salvation Army
Scholarship Program Application
___________________________________________________
_______________________
Last Name
Phone #
First Name
_________________________________________
Address
__________________
_____ _________
City
St
List all individuals in the household including the applicant
Last Name
First Name
Monthly Income:
Amount
Age
Sex
Relationship
Monthly Expenses:
Amount
____________
Zip
Applicant
Amount
Husband Employment
____________
Rent/Mortgage
Wife Employment
____________
Electric
Other Employment
____________
Water/Sewer
TANF
____________
Loans
Disability
____________
Groceries
____________
Entertainment ____________
Social Security
____________
Car Payment
____________
Medical Bills ____________
SSI
____________
Car Insurance
____________
Medical Ins
Child Support
____________
Gas
____________
Dental Ins
____________
Food Stamps
____________
Telephone/Cell
____________
Life Ins
____________
Other Income
____________
Cable/Internet
____________
Other
____________
Total Income
____________
____________
Credit Card
____________
Eating Out
____________
____________
Day Care
____________
____________
Education
____________
____________
Total Expenses ___________
Total Income – Expenses = _____________
Comments:
_______________________________________________________________________________________
_______________________________________________________________________________________
I certify that all information contained in this application is complete and accurate. I understand that giving
false information could result in my application being denied. I also understand that by completing this
application I am not guaranteed a scholarship.
Signature: ______________________________________________________Date: ____________
*Please be sure this application is filled out completely and accurately. Proof of all household income must accompany
this form. Applications with missing documentation or incomplete information will not be considered.
Rev. 1/4/16