Poway Pop Warner (PPW)

Size: px
Start display at page:

Download "Poway Pop Warner (PPW)"

Transcription

1 Financial Aid Guidelines 1. Financial Aid Requests must be made in writing at the time of registration. All financial aid applications are subject to PPW review and approval. 2. PPW Football financial aid applicants are required to provide a non-refundable 50% down-payment per participant towards registration fees. 3. PPW Cheer financial aid applicants are required to provide a non-refundable 50% down-payment per participant towards registration and uniform fees. 4. Financial aid applicants are required to complete and submit a PPW Financial Aid Application, Financial Aid Contract, and a copy of their previous year s tax return at the time of registration. AFDC, Cal Works, SDI and SSI recipients must include a copy of their disbursement voucher. 5. Financial applications will be ranked based on financial need, and awarded / approved based on the availability of funds. 6. In the event that a financial aid applicant requires additional time to provide the required financial supporting documentation, he or she may be given one month (30 calendar days) from the date of registration to submit required financial documents. If the paperwork is not received within this time; a. financial approval will not be considered. b. full registration fees will be required by June 30 in order for the child/children to remain eligible to participate. 7. In the event that partial financial aid is granted, the family will be responsible for all remaining fees. 8. The below criteria will be used in determining financial need: Household Size Full Financial Aid Partial Financial (# of People) Annual Income Annual Income 1 $13,273 $18,889 2 $17,797 $25,327 3 $22,321 $31,765 4 $26,845 $38,203 5 $31,369 $44,641 6 $35,893 $51,079 7 $40,417 $57,517 8 $44,941 $63,955 Please note: Failure to fulfill all financial aid requirements will result in denial of future financial aid requests. Submitting a Financial Aid application in no way guarantees that it will be awarded/approved/granted.

2 Financial Aid Application Please complete this application in full, sign and return to the PPW Treasurer at the time of registration. The information you provide will not be reviewed by anyone outside of the PPW Executive Board of Directors. The information will be used solely to determine whether your child is eligible for financial aid. Please be advised that scholarship funds are extremely limited. The number of scholarships that PPW is able to provide to families in need is dependent upon the association funds available. 1. Within 30 days of registration, complete and submit a PPW Financial Aid Application and Financial Contract along with a copy of your previous year s tax return. AFDC, Cal Works, SDI and SSI recipients must include a copy of their disbursement voucher. All documents must be received and evaluated prior to the recipient s receipt of equipment. 2. PPW Football financial aid participants are required to provide a mandatory 50% non-refundable down-payment per participant towards registration fees at the time of registration. 3. PPW Cheer financial aid applicants are required to provide a mandatory non-refundable 50% down-payment per participant towards registration and uniform fees. 4. The application must include: a. Names of all children living at home. b. Names of all adult members in the home and the income total that each adult contributes to the household per month, and the income source. 5. Gross Income must be documented for each household (member's income before taxes or other deductions). To figure monthly income, multiply weekly amount by 4.33, or bi-monthly amount by Names of Children in Household Adult Household Members & Monthly Income Amounts Name Gross Earnings Pension AFDC/SSI Other Income "I certify that all of the above information to be true and correct and that all income is reported. I understand the information provided will be reviewed by the PPW Executive Board, in the strictest of confidence, and that they may verify the information given. I also agree that any misrepresentation on my part will be reason enough for this application to be dismissed. I also agree that any misrepresentation on my part will result in denial of any form of financial aid", signed: Signature: Printed Name: Home Phone: Cell Phone: There is no guarantee that financial aid will be granted by submitting a financial aid application. After careful review of this application, you will be notified in writing of the PPW Association's decision to approve or deny your request.

3 Player's Name: Financial Aid Contract (One Contract per Child. Please attach any additional Player per Household Contracts as appropriate) Player s Priority Number: Division: FB / CH (circle one) Parent / Guardian Name: Phone: Upon PPW Board approval of request for financial aid, PPW requires a non-refundable down payment of 50% per player towards registration fees, plus a non-refundable 50% down payment towards any other/additional league fees (e.g. Cheer uniform costs.) at the time of registration. Amt. of Fee Paid: Rc'd by: (PPW Treasurer to complete/check One) Financial aid applicants are required to complete and submit a PPW financial aid contract along with a copy of their previous year s tax return within 30 days of registration. AFDC, Cal Works, SDI and SSI recipients must include a copy of their disbursement voucher. All documents must be received and evaluated prior to the recipient s receipt of equipment. W2: AFDC: Cal Works: Disbursement Voucher: (PPW Treasurer to complete/check One) Please provide an explanation of why you require Financial Aid for your child to participate in PPW: Failure to fulfill all financial aid requirements will result in denial of future financial aid requests..refunds shall be in accordance with our Refund Policy contained on the Parent Contact Information & Agreement form. "I understand the terms stated in the PPW Financial Aid Guidelines, Financial Aid Application, and Financial Aid Contract and agree to abide by them", signed: Parent / Guardian Signature:

4 Player's Name: Delayed Payment Contract (Page 1 of 2) (One contract per child. Please attach any Additional Player per Household** Contracts as appropriate) Player s Priority Number: Division: FB / CH (circle one) Parent / Guardian Name: Phone: PPW agrees to accept delayed payments for the registration of this participant on the condition that the above named parent /guardian agrees to abide by the following contract. Failure to adhere to this agreement in any way will result in forfeiture of any fees paid to PPW: 1. PPW Football participants are required to provide a non-refundable 50% down-payment per player towards registration fees at the time of registration in order to hold their spot on our priority list. 2. PPW Cheer participants are required to provide a non-refundable 50% down-payment per participant towards registration and uniform fees at the time of registration. 3. Completion of additional payment towards balance due for fees are required in accordance with the schedule as identified below. 4. All payments MUST be made on time (by the indicated due date in this contract). 5. The sum of the entire balance due must be paid off in full no later than June Failure to pay on time and/or to pay for the indicated amount balance due by June 30 will result in the participant's loss of his/her priority number and he/she being placed on a waiting list. This will result in the child being unable to receive equipment or participate in any way in PPW football/cheer activities until ALL fees are paid in full. 7. Refunds of any fees shall be in accordance with our refund policy contained on the Parent Contact and Information Form. Non-refundable 50% Down Payment: Due at Registration Today s Paid By: Cash: Check #: Received By: Payment : Due Paid By: Cash: Check #: Received By:

5 Payment : Delayed Payment Contract (Page 2 of 2) (One contract per child. Please attach any Additional Player per Household** Contracts as appropriate) Due Paid By: Cash: Check #: Received By: Payment: (total balance due is required no later than June 30) Due Paid By: Cash: Check #: Received By: Failure to fulfill all financial aid requirements will result in denial of future financial aid request. Refunds shall be in accordance with our Refund Policy contained on the Parent Contact Information & Agreement form. "I understand the terms stated in the PPW Delayed Payment Contract and agree to abide by them", signed: Parent / Guardian Signature: Parent / Guardian Printed Name:

CEO AMERICA, Lehigh Valley

CEO AMERICA, Lehigh Valley CEO AMERICA, Lehigh Valley 33 SOUTH SEVENTH STREET, SUITE 300, ALLENTOWN, PA 18101 Phone (610) 776-8740 ~ www.ceoamerica.net 2015 Student Scholarship Application ------------------------------------------------------------------------------------------------------------

More information

Copy of all 2017 W-2 forms (Please include W-2 forms for all persons in household). Please cross off social security numbers.

Copy of all 2017 W-2 forms (Please include W-2 forms for all persons in household). Please cross off social security numbers. TRANSFORMING LIVES Open Doors Financial Aid Application Thank you for your interest in the YMCA of Greensboro s financial aid Program. Attached you will find the application for the financial aid Program.

More information

Randolph-Asheboro YMCA Application for Scholarship Assistance

Randolph-Asheboro YMCA Application for Scholarship Assistance Randolph-Asheboro YMCA Application for Scholarship Assistance Because the Randolph-Asheboro YMCA has a limited number of scholarships available, we strive to be selective by granting assistance to those

More information

NAHASDA Housing Rental & Emergency Program Application

NAHASDA Housing Rental & Emergency Program Application 23701 South 655 Road, Hwy 10 Phone (918) 787-5452 Ext 6060 Toll Free (866) 787-5452 Fax (918) 516-0591 Email: tgrayson@sctribe.com NAHASDA Housing Rental & Emergency Program Application Housing Assistance

More information

OPEN DOORS FINANCIAL AID APPLICATION

OPEN DOORS FINANCIAL AID APPLICATION OPEN DOORS FINANCIAL AID APPLICATION Applicant Information Adult (or parent/guardian if applicant is a youth) Last First M.I. Gender DOB_ Street City State Zip Code Home / Cell Phone: Work Phone: E-mail:

More information

WELCOME TO ALL SCHOLARSHIP PROGRAM

WELCOME TO ALL SCHOLARSHIP PROGRAM WELCOME TO ALL SCHOLARSHIP PROGRAM What is the YMCA s WELCOME TO ALL SCHOLARSHIP PROGRAM? At the YMCA of Klamath Falls we believe that No one should be turned away for the inability to pay. The Welcome

More information

SOUTHERN CALIFORNIA JUNIOR ALL AMERICAN CONFERENCE, INC PLAYER'S SEASON CONTRACT (PLEASE READ CAREFULLY) Rev. 1/16

SOUTHERN CALIFORNIA JUNIOR ALL AMERICAN CONFERENCE, INC PLAYER'S SEASON CONTRACT (PLEASE READ CAREFULLY) Rev. 1/16 SOUTHERN CALIFORNIA JUNIOR ALL AMERICAN CONFERENCE, INC. 2019 PLAYER'S SEASON CONTRACT (PLEASE READ CAREFULLY) Rev. 1/16 SECTION I SCJAAFC Chapter Apple Valley Team Name Rebels CHECK STATUS NEW RETURNING

More information

Address. PLEASE PRINT. PLEASE ANSWER ALL QUESTIONS! Do not leave any space or blanks, write NO or N/A where appropriate.

Address. PLEASE PRINT. PLEASE ANSWER ALL QUESTIONS! Do not leave any space or blanks, write NO or N/A where appropriate. APPLICATION for LOW INCOME HOUSING TAX CREDIT (LIHTC) PROPERTY Project Name Unit # No. of Bedrooms Phone (home) (Cell) (work) Current Address: Email Address PLEASE PRINT. PLEASE ANSWER ALL QUESTIONS! Do

More information

Financial Assistance Application

Financial Assistance Application Financial Assistance Application The Johnston Urbandale Soccer Club wants to ensure all children are given the opportunity to participate in the sport of soccer regardless of their household income. Please

More information

ADMINISTRATIVE PLAN FOR THE HOMEOWNERSHIP PROGRAM. Housing Authority of the County of Riverside

ADMINISTRATIVE PLAN FOR THE HOMEOWNERSHIP PROGRAM. Housing Authority of the County of Riverside ADMINISTRATIVE PLAN FOR THE HOMEOWNERSHIP PROGRAM Housing Authority of the County of Riverside 2008 TABLE OF CONTENTS GENERAL PROVISIONS...3 A. FAMILY ELIGIBILITY REQUIREMENTS...4 1. First-Time Homeowner...

More information

R E S I D E N T I N F O R M A T I O N :

R E S I D E N T I N F O R M A T I O N : 1 R H o m e P r o p e r t y M a n a g e m e n t, L L C A p p l i c a t i o n f o r R e s i d e n c y ( M a r y l a n d / T a x C r e d i t ) Please Print Clearly: Fill in form completely to the best of

More information

Indy Premier SC Financial Assistance Policy

Indy Premier SC Financial Assistance Policy Section IV. Indy Premier SC Financial Assistance Policy 1.0 Financial Assistance. Indy Premier Soccer Club ( Indy Premier ) believes in providing a quality soccer experience at all age levels and capabilities

More information

SOUTHWEST LOCAL WORKFORCE DEVELOPMENT BOARD 1527 White Avenue Henderson, TN (731)

SOUTHWEST LOCAL WORKFORCE DEVELOPMENT BOARD 1527 White Avenue Henderson, TN (731) SOUTHWEST LOCAL WORKFORCE DEVELOPMENT BOARD 1527 White Avenue Henderson, TN 38340 (731) 989-5111 Effective Date: July 26, 2018 Duration: June 30, 2020 Workforce Services Policy Support Services Southwest

More information

APPLICATION FOR AFFORDABLE HOUSING

APPLICATION FOR AFFORDABLE HOUSING APPLICATION FOR AFFORDABLE HOUSING WELCOME! We are very happy you are interested in Our Family Services affordable apartments. Our units are spacious, comfortable with a washer and dryer in each unit.

More information

APPLICATION FOR RESIDENCY

APPLICATION FOR RESIDENCY of Application: (Each co-resident must submit separate application) APPLICATION FOR RESIDENCY FOR OFFICE USE ONLY REFERRED BY APT NO MONTHLY RENT APT TYPE SECURITY DEPOSIT CONCESSION AMT SET ASIDE % PERSONAL

More information

Genesee Valley Bills Youth Football & Cheerleading Organization Registration Form

Genesee Valley Bills Youth Football & Cheerleading Organization Registration Form Genesee Valley Bills Youth Football & Cheerleading Organization Registration Form Participant Information Full Name: First Last Address: Street Address Apartment/Unit # City State ZIP Code Home Phone:

More information

POMERENE HOSPITAL CHARITY CARE PROGRAM REQUIREMENT LIST

POMERENE HOSPITAL CHARITY CARE PROGRAM REQUIREMENT LIST POMERENE HOSPITAL CHARITY CARE PROGRAM REQUIREMENT LIST Name of Patient: Date of Service: Account Number: Dear Applicant, Enclosed please find an application for the Pomerene Hospital Charity Care program.

More information

LIHTC RENTAL APPLICATION

LIHTC RENTAL APPLICATION LIHTC RENTAL APPLICATION CHECK PHOTO ID SOCIAL SECURITY NUMBER VERIFIED MANAGER USE ONLY: DATE RECEIVED TIME RECEIVED MANAGER INITIAL APT # # OF BEDROOMS RENT AMOUNT LEASE TERM APPLICANT TYPE APPLICANT

More information

NAHASDA Housing Rental & Emergency Program Application

NAHASDA Housing Rental & Emergency Program Application 23701 South 655 Road, Hwy 10 Phone (918) 787-5452 Ext 110 Toll Free (866) 787-5452 Fax (918) 516-0591 Email: mmorris@sctribe.com NAHASDA Housing Rental & Emergency Program Application The Seneca-Cayuga

More information

GUIDELINES FOR PASS PLAN SCHOLARSHIPS COMMUNITY CENTER PASS PLAN / PROGRAM / ACTIVITIES

GUIDELINES FOR PASS PLAN SCHOLARSHIPS COMMUNITY CENTER PASS PLAN / PROGRAM / ACTIVITIES GUIDELINES FOR PASS PLAN SCHOLARSHIPS COMMUNITY CENTER PASS PLAN / PROGRAM / ACTIVITIES TOWN OF WYTHEVILLE PARKS AND RECREATION DEPARTMENT GUIDELINES FOR PASS PLAN SCHOLARSHIP PROGRAM Applications are

More information

RENTAL APPLICATION CHECKLIST

RENTAL APPLICATION CHECKLIST RENTAL APPLICATION CHECKLIST Please note: The application will not be accepted with incomplete information and missing documentation. All documents requested must be provided. Name: Date & Time: Applicant(s)

More information

VOLUSIA ENDOSCOPY AND SURGERY CENTER. SUBJECT: PATIENT FINANCIAL COUNSELING & PAYMENT PLANS Page 1 of 2 POLICY: BO-28 EFFECTIVE DATE: APPROVED BY:

VOLUSIA ENDOSCOPY AND SURGERY CENTER. SUBJECT: PATIENT FINANCIAL COUNSELING & PAYMENT PLANS Page 1 of 2 POLICY: BO-28 EFFECTIVE DATE: APPROVED BY: SUBJECT: PATIENT FINANCIAL COUNSELING & PAYMENT PLANS Page 1 of 2 POLICY: BO-28 EFFECTIVE DATE: APPROVED BY: DATE REVIEWED: DATE REVISED: PURPOSE To describe parameters for appropriate, adequate and timely

More information

APPLICATION FOR HOUSING

APPLICATION FOR HOUSING APPLICATION FOR HOUSING PROPERTY NAME: DATE: TIME: Applications are placed in order of date received. An applicant may be interviewed only after the receipt of this tenant application, which must be fully

More information

YMCA of Greenwich Scholarship Application

YMCA of Greenwich Scholarship Application YMCA of Greenwich Scholarship Application The YMCA of Greenwich enriches the community by promoting positive values through programs that build healthy kids and strong families. Please take your time completing

More information

HOUSING AUTHORITY OF THE CITY OF PRICHARD Application for Admission Public Housing

HOUSING AUTHORITY OF THE CITY OF PRICHARD Application for Admission Public Housing For Office Use only. Applicants should not write in this section. Date/Time: Received by: Special Assistance required by this applicant: Bedroom Size Interview Date: TO BE FILLED OUT BY APPLICANT (IN INK).

More information

APPLICATION FOR SCHOLARSHIP MEMBERSHIP

APPLICATION FOR SCHOLARSHIP MEMBERSHIP APPLICATION FOR SCHOLARSHIP MEMBERSHIP The Skagit Valley Family YMCA provides financial assistance to the extent possible to those in need. Proof of income is required and eligibility is determined by

More information

ADVENTURE AWAITS! Exceptional Outdoor Experiences That Last a Lifetime.

ADVENTURE AWAITS! Exceptional Outdoor Experiences That Last a Lifetime. ADVENTURE AWAITS! Exceptional Outdoor Experiences That Last a Lifetime. YMCA MISSION The Valley of the Sun YMCA is a community service organization which promotes positive values through programs that

More information

FHLBank Topeka Affordable Housing Program (AHP) and Homeownership Set-aside Program (HSP) Income Calculation Guide

FHLBank Topeka Affordable Housing Program (AHP) and Homeownership Set-aside Program (HSP) Income Calculation Guide FHLBank Topeka Affordable Housing Program (AHP) and Homeownership Set-aside Program (HSP) Income Calculation Guide INCOME CALCULATION GUIDELINES... 2 GENERAL POLICY... 2 INCOME CALCULATION WORKBOOK...

More information

YMCA CAMP SCHOLARSHIP & DHS/RICCAP CHECK-OFF LIST

YMCA CAMP SCHOLARSHIP & DHS/RICCAP CHECK-OFF LIST YMCA CAMP SCHOLARSHIP & DHS/RICCAP CHECK-OFF LIST If this application is not filled out properly or all the documentation is not included, the parent/guardian will be notified by phone. This will definitely

More information

CANTERBURY WELFARE APPLICATION

CANTERBURY WELFARE APPLICATION All applications must be hand delivered to the Welfare Department during office hours. CANTERBURY WELFARE APPLICATION TO THE APPLICANT: If you are requesting any assistance from the Canterbury Welfare

More information

Thank you for your interest in the Apartment rental. APPLICATION REQUIREMENTS for PROSPECTIVE TENANTS and GUARANTORS:

Thank you for your interest in the Apartment rental. APPLICATION REQUIREMENTS for PROSPECTIVE TENANTS and GUARANTORS: Thank you for your interest in the Apartment rental APPLICATION REQUIREMENTS for PROSPECTIVE TENANTS and GUARANTORS: Completed Rental Application for each adult Occupant and completed Guarantor Application

More information

Magnolia at Mesquite Creek Rental Selection Criteria

Magnolia at Mesquite Creek Rental Selection Criteria Magnolia at Mesquite Creek Rental Selection Criteria EQUAL HOUSING OPPORTUNITY 900 Gross Rd. Mesquite TX 75149 (972) 216 0600 Fair Housing and Equal Opportunity Requirements This community is an Equal

More information

Metro Loma Rental Selection Criteria

Metro Loma Rental Selection Criteria Metro Loma Rental Selection Criteria EQUAL HOUSING OPPORTUNITY 328 Mira Loma Glendale, CA 91204 (818) 241-2389 Fair Housing and Equal Opportunity Requirements This community is an Equal Opportunity Housing

More information

PRC EMPLOYMENT MATERIAL CHECKLIST {UNIFORMS, FOOTWEAR, TOOLS, & EQUIPMENT} **VERIFICATIONS REQUIRED FOR PROCESSING YOUR PRC APPLICATION:

PRC EMPLOYMENT MATERIAL CHECKLIST {UNIFORMS, FOOTWEAR, TOOLS, & EQUIPMENT} **VERIFICATIONS REQUIRED FOR PROCESSING YOUR PRC APPLICATION: PRC EMPLOYMENT MATERIAL CHECKLIST {UNIFORMS, FOOTWEAR, TOOLS, & EQUIPMENT} NAME: CASE NUMBER: DUE BY: **VERIFICATIONS REQUIRED FOR PROCESSING YOUR PRC APPLICATION: YOU MUST HAVE MINOR CHILD IN HOME OR

More information

Adult Day Care CACFP

Adult Day Care CACFP Adult Day Care CACFP Eligibility Determination Chapter 5 Eligibility Determination 5-1 Eligibility Determination Eligibility Category Just What IS Eligibility Determination? Eligibility determination is

More information

CHARITY CARE DISCOUNT POLICY

CHARITY CARE DISCOUNT POLICY CHARITY CARE DISCOUNT POLICY POLICY STATEMENT The Hospital shall contribute appropriate resources, advocacy and community support to promote the health status of the community, which it serves, within

More information

COMMUNITY: PROGRAM: ORIGINAL DATE: TIME: UPDATE: TIME:

COMMUNITY: PROGRAM: ORIGINAL DATE: TIME: UPDATE: TIME: SUBJECT: APPLICANT FOR RESIDENCY TAX CREDIT COMMUNITIES COMMUNITY: PROGRAM: ORIGINAL DATE: TIME: UPDATE: TIME: HOW DID YOU HEAR ABOUT US? APARTMENT SIZE: APPLICANT NAME (FIRST, MIDDLE, LAST): CURRENT ADDRESS:

More information

Student s Name: Grade. The parent/guardian requesting financial aid is required to provide the following with this application.

Student s Name: Grade. The parent/guardian requesting financial aid is required to provide the following with this application. Application Date: Worthy Student Application Student s Name: Grade The parent/guardian requesting financial aid is required to provide the following with this application. Parent/Guardian Information:

More information

SUBJECT: APPLICATION FOR RESIDENCY

SUBJECT: APPLICATION FOR RESIDENCY SUBJECT: APPLICATION FOR RESIDENCY COMMUNITY: PROGRAM: ORIGINAL DATE: TIME: UPDATE: TIME: HOW DID YOU HEAR ABOUT US? APPLICANT NAME: APARTMENT SIZE: CURRENT ADDRESS: CITY STATE, ZIP: HOME PHONE #: WORK

More information

9.00 COMPARABLE SERVICES AND BENEFITS

9.00 COMPARABLE SERVICES AND BENEFITS 9.00 COMPARABLE SERVICES AND BENEFITS Definition Comparable services and benefits refer to any appropriate service, financial benefit or assistance available to a consumer from a program other than VR

More information

RENTAL APPLICATION. Total number of occupants to live in apartment: Adults Children Do you have a pet? Yes No If yes, describe:

RENTAL APPLICATION. Total number of occupants to live in apartment: Adults Children Do you have a pet? Yes No If yes, describe: RENTAL APPLICATION : Time: Desired: Full Name of Applicant Social Security Number Male Female of Birth Full Name of Co-Applicant Social Security Number Male Female of Birth Children s Names Male Female

More information

Chapter 2 ELIGIBILITY & DOCUMENTATION

Chapter 2 ELIGIBILITY & DOCUMENTATION Chapter 2 ELIGIBILITY & DOCUMENTATION Clients must meet certain eligibility criteria to receive Ryan White Funds. Clients must: 1. Be HIV seropositive 2. Meet low-income requirements 3. Have no insurance

More information

WE WILL NOT REVIEW INCOMPLETE APPLICATIONS.

WE WILL NOT REVIEW INCOMPLETE APPLICATIONS. Application Screening Policies and Fees Active Property Services represents the owners of this property. We are an equal housing opportunity property service and offer applications to anyone who requests

More information

Affordable Housing Program and Homeownership Set-aside Program. Income Calculation Guide

Affordable Housing Program and Homeownership Set-aside Program. Income Calculation Guide Affordable Housing Program and Homeownership Set-aside Program Income Calculation Guide Table of Contents Income Calculation Guidelines... 2 General Policy... 2 Income Calculation Workbook... 2 Income

More information

YWCA OF WESTERN MASSACHUSETTS Supportive Housing Program APPLICATION FOR HOUSING

YWCA OF WESTERN MASSACHUSETTS Supportive Housing Program APPLICATION FOR HOUSING YWCA OF WESTERN MASSACHUSETTS Supportive Housing Program APPLICATION FOR HOUSING Program Description The YWCA Supportive Housing Program is an 18-24 month supportive housing program that is designed to

More information

INSTRUCTIONS FOR FEE WAIVER

INSTRUCTIONS FOR FEE WAIVER INSTRUCTIONS FOR FEE WAIVER 1. After you have completed the fee waiver form, take it to a notary public the form must be notarized. NOTE: Make sure your phone number is at the top of the first page. 2.

More information

A S H LA N D A R EA YM CA

A S H LA N D A R EA YM CA ALWAYS HERE FOR YOU Scholarship Program ASHLAND AREA YMCA The ASHLAND AREA YMCA is a Christian based, not-for-profit, health and human services organization committed to helping people reach their full

More information

Affordable Housing Program and Homeownership Set-aside Program Income Calculation Guide

Affordable Housing Program and Homeownership Set-aside Program Income Calculation Guide Affordable Housing Program and Homeownership Set-aside Program Income Calculation Guide 2019 Updated: February 12, 2019 Table of Contents Income Calculation Guidelines... 2 General Policy... 2 Income Calculation

More information

INSTRUCTIONS FOR FEE WAIVER

INSTRUCTIONS FOR FEE WAIVER INSTRUCTIONS FOR FEE WAIVER 1. After you have completed the fee waiver form, take it to a notary public the form must be notarized. NOTE: Make sure your phone number is at the top of the first page. 2.

More information

APPLICATION PROCESS for RealAmerica Management

APPLICATION PROCESS for RealAmerica Management APPLICATION PROCESS for RealAmerica Management RENTAL GUIDELINES: 1. Falsification of information on an application is basis for denial. 2. All applicants and residents 18 years of age and older must complete

More information

Season Registration and Refund Policies

Season Registration and Refund Policies 2017-2018 Season Registration and Refund Policies Each player s registration cost will include and cover all of the following services and costs: Uniform (home and away jerseys, shorts, and socks) Two

More information

APPLICATION FOR HOUSING

APPLICATION FOR HOUSING Rotary Plaza 433 Alida Way South San Francisco, CA 94080 Phone (650) 871-5323 TDD (800)545-1833 ext. 478 E-mail: RPZ-Administrator@HumanGood.org Web: HumanGood.org For Office Use Only Date/Time Received:

More information

Clocktower Lofts Rental Selection Criteria

Clocktower Lofts Rental Selection Criteria Clocktower Lofts Rental Selection Criteria EQUAL HOUSING OPPORTUNITY 2500 Broadway, Ste. 406 Denver, CO 80202 (303) 789-9660 Fair Housing and Equal Opportunity Requirements This community is an Equal Opportunity

More information

Virginia Application for Dental Insurance

Virginia Application for Dental Insurance Section A. Dental Coverage Options: 1. Select who the coverage is for: Primary Applicant Only Primary Applicant and Dependent(s) Child(ren) Only 2. Select what coverage applicant(s) is/are applying for:

More information

401 E. Carson St. Carson, CA (424)

401 E. Carson St. Carson, CA (424) 01 E. Carson St. Carson, CA 9075 () 77-507 Dear Applicant: Thank you for your interest in Via 5 Apartments. In response to your request, attached you will find a Rental Application form. Please read through

More information

Tuition Assistance Application For the School Year Beginning August 2019

Tuition Assistance Application For the School Year Beginning August 2019 Tuition Assistance Application For the School Year Beginning August 2019 Information needed to complete your application: Copy of your 2018 IRS Federal Form 1040 or 1040A U.S. Individual Income Tax Return,

More information

OWNER OCCUPANT APPLICATION

OWNER OCCUPANT APPLICATION ERIE REDEVELOPMENT AUTHORITY APPLICATION FOR RESIDENTIAL CDBG/HOME PROGRAM Updated November 2017 OWNER OCCUPANT APPLICATION IMPORTANT: COMPLETE ENTIRE FORM TO AVOID PROCESSING DELAYS OR DENIAL OF APPLICATION

More information

Please sign and date application before returning to the Financial Counselor.

Please sign and date application before returning to the Financial Counselor. ***FINANCIAL ASSISTANCE APPLICATION*** Instruction Sheet Please be sure to attach a copy of the following to the completed application: 1. Copy of last paycheck stub, Social Security or Disability check

More information

Business Loan Guidelines

Business Loan Guidelines Business Loan Guidelines Loan applicants must be businesses located in Northeast Ohio that are unable to obtain the money from a conventional lender or other sources The maximum loan amount is $10,000

More information

Personal Declaration

Personal Declaration Initial Certification Annual Certification Income Change Household Change Personal Declaration YOU MUST COMPLETE THIS FORM AND BRING IT TO YOUR OFFICE APPOINTMENT. THIS FORM MUST BE SIGNED BY ALL ADULT

More information

RENTAL APPLICATION FOR HOUSING

RENTAL APPLICATION FOR HOUSING Kaniko`o, Phase II 4215 Hoala Street Lihue, HI 96766 Telephone: (808) 353-3938 Fax: (808) 353-3938 e-mail: RC-Management@eahhousing.org HI RB#16985, CA BRE# 853495 For Office Use Only /Time Received: Received

More information

YOUNG ARTIST SUMMER PROGRAM FINANCIAL ASSISTANCE APPLICATION FOR CCAR CROSS-BORDER SUMMER SCHOLARSHIP 2018

YOUNG ARTIST SUMMER PROGRAM FINANCIAL ASSISTANCE APPLICATION FOR CCAR CROSS-BORDER SUMMER SCHOLARSHIP 2018 YOUNG ARTIST SUMMER PROGRAM FINANCIAL ASSISTANCE APPLICATION FOR CCAR CROSS-BORDER SUMMER SCHOLARSHIP 2018 Council for Canadian American Relations Cross-Border Summer Scholarship covers tuition, housing

More information

Villages of Moaʻe Kū, Phase I

Villages of Moaʻe Kū, Phase I Villages of Moaʻe Kū, Phase I 91-1655 PAHIKA STREET EWA BEACH, HAWAII 96706 Phone (808) 681-3000 Fax (808) 681-3004 TDD (877) 447-5991 Web: www.eahhousing.org For Office Use Only /Time Received: Received

More information

APPLICATION FOR APARTMENT

APPLICATION FOR APARTMENT For Office Use Only. Application ID: APPLICATION FOR APARTMENT INSTRUCTIONS: 1. SUBMIT ONLY ONE APPLICATION PER HOUSEHOLD. You may be disqualified if more than one application is received per lottery for

More information

Instructions: Please follow carefully - Incomplete applications will be returned

Instructions: Please follow carefully - Incomplete applications will be returned The Caleb Group Mohawk Forest Apartments 201 Mohawk Forest Blvd. North Adams, MA 01247 Building Affordable Communities Instructions: Please follow carefully - Incomplete applications will be returned 1.

More information

Trip Participant Contract Seminole High School Pride of the Tribe June 3-10, 2019 France Trip*

Trip Participant Contract Seminole High School Pride of the Tribe June 3-10, 2019 France Trip* Trip Participant Contract Seminole High School Pride of the Tribe June 3-10, 2019 France Trip* Student Name Address City Zip Code Student Email Parent Name(s) Address (if different from above) City Zip

More information

CAMP TOCKWOGH OPEN DOORS

CAMP TOCKWOGH OPEN DOORS CAMP TOCKWOGH OPEN DOORS FINANCIAL ASSISTANCE The Y works to make sure that everyone has the opportunity to learn, grow & thrive. www.ymcade.org OPEN DOORS APPLICATION The YMCA of Delaware is a not-for-profit

More information

FLYERS AFTER SCHOOL PROGRAM APPLICATION FOR CHILD. Childs Information. Date of Application: Child s Name (first & last name)

FLYERS AFTER SCHOOL PROGRAM APPLICATION FOR CHILD. Childs Information. Date of Application: Child s Name (first & last name) FLYERS AFTER SCHOOL PROGRAM 2014-2015 APPLICATION FOR CHILD *All information must be complete in order to enroll Childs Information Child s Name (first & last name) Name of School and Grade Date of Birth

More information

Alaska Airlines Cheer on the Dawgs in Atlanta Sweepstakes Affidavit of Eligibility, Liability & Publicity Release

Alaska Airlines Cheer on the Dawgs in Atlanta Sweepstakes Affidavit of Eligibility, Liability & Publicity Release Alaska Airlines Cheer on the Dawgs in Atlanta Sweepstakes Affidavit of Eligibility, Liability & Publicity Release STATE OF COUNTY OF Alaska Airlines, Inc. ( Sponsor ) is the sponsor of the Alaska Airlines

More information

Round Lake Area Park District Encore! Summer Theatre Camp Cover Sheet

Round Lake Area Park District Encore! Summer Theatre Camp Cover Sheet Round Lake Area Park District Encore! Summer Theatre Camp Cover Sheet Child s Name Program Date Birthdate Home Phone Work Phone Cell Phone E-mail Camp Fee / Payment is Due with Completed Packet Cover Page

More information

HARBOR VILLAGE. 981 Harbor Village Drive, Harbor City, CA Telephone (310) FAX (310) CA Relay Center TTY

HARBOR VILLAGE. 981 Harbor Village Drive, Harbor City, CA Telephone (310) FAX (310) CA Relay Center TTY HARBOR VILLAGE 981 Harbor Village Drive, Harbor City, CA 90710 Telephone (310) 530-8711 FAX (310) 530-4364 CA Relay Center TTY 877-735-2929 April 26, 2017 Dear Prospective Applicant; Leasing Hours: Mon-Fri

More information

13.0 SUPPORTIVE SERVICES

13.0 SUPPORTIVE SERVICES 13.0 SUPPORTIVE SERVICES 13.1 Overview Supportive services are to be provided so participants can attend their WTW activity, accept an offer of employment, or remain employed. Supportive services are also

More information

Membership Scholarship Application

Membership Scholarship Application Membership Scholarship Application Please be advised that all required documents must be fully completed and turned in together in order to be processed. All documents must be legibly written in black

More information

WV INCOME MAINTENANCE MANUAL. Assets

WV INCOME MAINTENANCE MANUAL. Assets INTRODUCTION This Chapter contains the policies for determining asset eligibility for Food Stamp benefits, WV WORKS, AFDC Medicaid and most other Medicaid coverage groups. Instructions for determining

More information

HOUSING CHOICE VOUCHER (SECTION 8) INCOME ADJUSTMENT

HOUSING CHOICE VOUCHER (SECTION 8) INCOME ADJUSTMENT HOUSING CHOICE VOUCHER (SECTION 8) INCOME ADJUSTMENT INSTRUCTON FOR INCOME ADJUSTMENT: Complete attached Income Adjustment Packet & Release of Information form. Attach verification of ALL household income

More information

If you have questions, please contact our Patient Financial Services department at (925)

If you have questions, please contact our Patient Financial Services department at (925) Complete application must be received no later than 30 calendar days after the date of discharge. Or (due date) Dear Patient: Attached is the requested application for the Patient Assistance Program offered

More information

IDAHO INDIVIDUAL APPLICATION COVER SHEET FOR ENROLLMENT OUTSIDE OF THE IDAHO EXCHANGE

IDAHO INDIVIDUAL APPLICATION COVER SHEET FOR ENROLLMENT OUTSIDE OF THE IDAHO EXCHANGE IDAHO INDIVIDUAL APPLICATION COVER SHEET FOR ENROLLMENT OUTSIDE OF THE IDAHO EXCHANGE Welcome to Blue Cross of Idaho To apply for medical and/or dental coverage for 2016, complete this cover sheet and

More information

FINANCIAL ASSISTANCE APPLICATION: COVER LETTER

FINANCIAL ASSISTANCE APPLICATION: COVER LETTER FINANCIAL ASSISTANCE APPLICATION: COVER LETTER Thank you for choosing Children s of Alabama to provide for the healthcare needs of your child. Please find attached the forms you must complete in order

More information

PLEASANT VIEW APARTMENTS 202 Larry Lane Pauls Valley, OK

PLEASANT VIEW APARTMENTS 202 Larry Lane Pauls Valley, OK Application for Rental Housing PLEASANT VIEW APARTMENTS 202 Larry Lane Pauls Valley, OK 73075 405-207-9474 Office Use Only of Application Time of Application Size Unit Desired Agent: Complete this application

More information

Study Abroad/Short-Term Study Policy. Study Abroad Application

Study Abroad/Short-Term Study Policy. Study Abroad Application REVISED STUDY ABROAD/SHORT-TERM STUDY POLICY GUIDELINES OFFICE OF INTERNATIONAL PROGRAMS AND EXCHANGE OFFICE OF THE PROVOST AND VICE PRESIDENT FOR ACADEMIC AFFAIRS The attached revised guidelines pertaining

More information

SOBOBA TRIBAL TANF PROGRAM STATEMENT OF FACTS

SOBOBA TRIBAL TANF PROGRAM STATEMENT OF FACTS 1. APPLICANT/HEAD OF HOUSEHOLD: Address: City, State, Zip Code: Phone #: ( ) Social Security Number: Date of Birth: Driver s License/ID #: Exp. Email Address: Other: Marital Status: Single, never married

More information

phone fax

phone fax 480-898-0228 phone 480-898-9007 fax www.affordablerental.org Save the Family's Transitional Program was designed to promote self-sufficiency and stabilize family lifestyles with the community through intensive

More information

ATHENS YMCA CAMP KELLEY SUMMER CAMP 2018

ATHENS YMCA CAMP KELLEY SUMMER CAMP 2018 ATHENS YMCA CAMP KELLEY SUMMER CAMP 2018 POLICIES Cost: Full Week (5 Days) $115, Half Week (3 Days) $70; Additional Children: Any additional children will receive a $10 discount on full weeks ONLY. Registration

More information

RELEASE OF INFORMATION The attached document is a state required form.

RELEASE OF INFORMATION The attached document is a state required form. RELEASE OF INFORMATION The attached document is a state required form. FROM: WALNUT GROVE APARTMENTS 3100 S. WALNUT STREET PIKE BLOOMINGTON, IN 47401 Phone: (812) 339-3980 Fax: (812) 339-1037 The undersigned

More information

SECTION: Page 1 of 12

SECTION: Page 1 of 12 SECTION: Page 1 of 12 NUMBER: Revision Level: 0 FORMULATED: TITLE: Medical Financial Assistance Program REVISED: APPROVAL: TITLE: Chief Financial Officer or Designee REVIEWED: SIGNATURE: This document

More information

Master Trusts General information.

Master Trusts General information. Master Trusts Master Trusts were created to hold in trust the money and property intended for the use and benefit of children who either are receiving services from DCF or are in DCF s legal custody. Government

More information

Region 5 Weekend Educational March 3 4, 2018 Special IWD Women s Educational Treasurers & Stewards Courses

Region 5 Weekend Educational March 3 4, 2018 Special IWD Women s Educational Treasurers & Stewards Courses Region 5 Weekend Educational March 3 4, 2018 Special IWD Women s Educational Treasurers & Stewards Courses 1 January 16, 2018 To: From: Region 5 L.E.C.s, Stewards, E.B.M.s, and Staff Region 5 Education

More information

PALOS VERDES PENINSULA UNIFIED SCHOOL DISTRICT

PALOS VERDES PENINSULA UNIFIED SCHOOL DISTRICT PALOS VERDES PENINSULA UNIFIED SCHOOL DISTRICT High School Independent Study Physical Education (ISPE) Checklist The following documents must be completed and submitted to your student s counselor for

More information

PLEASE READ EVERYTHING COMPLETELY BEFORE FILLING OUT THE ELIGIBILITY QUESTIONNAIRE

PLEASE READ EVERYTHING COMPLETELY BEFORE FILLING OUT THE ELIGIBILITY QUESTIONNAIRE Homebuyer Eligibility Questionnaire Packet The Habitat for Humanity program is one in which you purchase a Habitat house or rehab that you also help build! The qualifications are that you have a need for

More information

D & L REPRESENTATIVE PAYEE SERVICES

D & L REPRESENTATIVE PAYEE SERVICES D & L REPRESENTATIVE PAYEE SERVICES P.O. BOX 1637, WALNUT, CA 91788-1637 A 501(c)(3) Non-Profit REPRESENTATIVE PAYEE SERVICES APPLICATION Client Information: Name: Address: City: State: Zip: Move In Date:

More information

APPLICATION QUESTIONAIRE

APPLICATION QUESTIONAIRE PLEASE FAX THIS APPLICATION TO YOUR RESIDENCE OF CHOICE. ALL FAX NUMBERS ARE LISTED ON THE WEBSITE. Date of Application: Date of Application Time of Application No. of Bedrooms APPLICANT NAME(S) Home Phone

More information

NMH HIPAA Privacy Training Version

NMH HIPAA Privacy Training Version NMH HIPAA Privacy Training 2017 Version Training Objectives To gain a better understanding of: The Notice of Privacy Practices Access Monitoring Keeping Customer Information Private Minimum Necessary Requirements

More information

The following procedures shall be used to determine the responsible party s ability to pay:

The following procedures shall be used to determine the responsible party s ability to pay: MCCMH MCO Policy 10-060 FINANCIAL LIABILITY PROCEDURES Date: 8/06/09 VI. Procedures A. Admission Process: The following procedures shall be used to determine the responsible party s ability to pay: 1.

More information

New Jersey Department of Children and Families Policy Manual. Date: Chapter: A Independent Living Subchapter: 2 Stipends

New Jersey Department of Children and Families Policy Manual. Date: Chapter: A Independent Living Subchapter: 2 Stipends New Jersey Department of Children and Families Policy Manual Manual: CP&P Child Protection and Permanency Effective Volume: VI Adolescent Services Date: Chapter: A Independent Living Subchapter: 2 Stipends

More information

Blackfeet Housing General Application ITEMS NEEDED FOR APPLICATION THE FOLLOWING ITEMS NEED TO BE WITH YOUR APPLICATION BEFORE YOU TURN IT IN:

Blackfeet Housing General Application ITEMS NEEDED FOR APPLICATION THE FOLLOWING ITEMS NEED TO BE WITH YOUR APPLICATION BEFORE YOU TURN IT IN: Blackfeet Housing General Application INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED INSTRUCTIONS ON COMPLETING YOUR APPLICATION ITEMS NEEDED FOR APPLICATION THE FOLLOWING ITEMS NEED TO BE WITH YOUR APPLICATION

More information

Petition for Policy Exception [PPE]

Petition for Policy Exception [PPE] 1. Instructions Bates Technical College Petition for Policy Exception 1. The Petition for Policy Exception (PPE) is a formal request for an exception to a published College policy. It can be approved only

More information

HealthSource Saginaw, Inc. ADMINISTRATIVE MANUAL FINANCIAL ASSISTANCE A-090

HealthSource Saginaw, Inc. ADMINISTRATIVE MANUAL FINANCIAL ASSISTANCE A-090 HealthSource Saginaw, Inc. ADMINISTRATIVE MANUAL FINANCIAL ASSISTANCE A-090 POLICY: PURPOSE: PROCEDURE: Healthsource Saginaw will grant financial assistance to patients/residents who cannot pay for services

More information

What is the Sliding Fee Discount Program?

What is the Sliding Fee Discount Program? SLIDING FEE DISCOUNT PROGRAM Kung kailangan mo ng tulong sa translation magyaring hilingin sa front desk. Si necesita ayuda con la traducción, por favor pedir a la recepción. What is the Sliding Fee Discount

More information

EMERGENCY REPAIR OF PRIVATELY OWNED HOMES PROGRAM

EMERGENCY REPAIR OF PRIVATELY OWNED HOMES PROGRAM MUSCOGEE (CREEK) NATION DEPARTMENT OF HOUSING P. O. BOX 297 / Okmulgee, OK 74447 / 918 549-2500 /1-800-482-1979 APPLICATION FOR THE EMERGENCY REPAIR OF PRIVATELY OWNED HOMES PROGRAM For Office Use Only

More information

a. Family b. Elderly/ Handicapped c. Handicapped d. MRVP

a. Family b. Elderly/ Handicapped c. Handicapped d. MRVP LEXINGTON HOUSING AUTHORITY One Countryside Village Lexington, MA 02420 781-861-0900 STANDARD APPLICATION FOR STATE-AIDED HOUSING THIS BOX IS FOR OFFICE USE ONLY Date of receipt: Time of Receipt: Control

More information