Summer Camp Scholarship for New Families

Scholarship Application: Summer Camp for New Families
 
Club K After School Zone provides a limited number of partial scholarships to working families who demonstrate significant financial need for Summer Camp services. Families may self-refer or be referred by school personnel. All families are expected to contribute to their child’s/children’s tuition.

A completed scholarship application is required as well as supporting documentation. Families must register for the program, select preferred weeks/days and pay the registration fee prior to submitting a scholarship application. If your child is currently enrolled in a Club K After School Zone location, you are responsible for full payment for any program fees that occur prior to receiving financial assistance.

Families must also meet eligibility requirements including, but not limited to: income, household size, family circumstances, eligibility for DHS subsidy, amount of scholarship funds available and program space available. The Scholarship Committee meets monthly. Any scholarships approved by the Scholarship Committee are final and are not negotiable. Scholarships are not retroactive and fees must be paid and current in the interim. Please complete all lines and include all requested documentation. Completed application packets received by the 1st of the month are reviewed at that month’s Scholarship Committee Meeting. Incomplete applications will not be considered.

Please give us an indication of your child’s preferred attendance schedule below so our Scholarship Committee can determine and allocate scholarship funds for your family based on the funding Club K After School Zone has available at the time of your application. Families are required to submit a Summer Camp Registration Form, Consent Form, Tuition Agreement, and Tuition Express Form (including a voided check or direct deposit form) to our Registration Department as part of the registration process.

Application Information

Application Information

Attendance Schedule

1st Child's information (Click arrow to enter information) >>>

2nd Child's information (Click arrow to enter information) >>>

3rd Child's information (Click arrow to enter information) >>>

Financial information

Have you applied for a DHS subsidy through ERDC (Employment Related Day Care)? *
All families are expected to apply for assistance through DHS prior to applying for a scholarship with Club K.
To apply: https://www.oregon.gov/DHS/ASSISTANCE/CHILD-CARE/Pages/Parents.aspx
Do you qualify for a DHS subsidy (ERDC-Employment Related Day Care)? *

Required Supporting Documents

 
Attach copies of the following documentation & attach with this application below:

  1. Prior year's Federal Tax Return (include all schedules) for each adult in your household
  2. Prior year's W-2 for each adult in your household
  3. Two (2) most recent pay stubs or unemployment checks for each adult in your household
  4. Financial Aid award letter if you are a student in school

AND, is applicable, attach copies of the following:

  1. If you are divorced or separated, you must attach copies of the appropriate pages from your recorded judgement that outlines:
    1. Child care fee payment responsibility
    2. Monthly child support amount
    3. Monthly spousal support
  2. DHS Subsidy and co-pay letter from your caseworker
  3. Worker's compensation check
  4. Any other untaxed income not reported
Upload your prior years Federal Tax Return here: *
Maximum upload size: 134.22MB
Upload your prior years W-2's here: *
Maximum upload size: 134.22MB
Upload your 2 most recent paystubs here: (upload together as one document please): *
Maximum upload size: 134.22MB
Upload any other supporting documents here:
Maximum upload size: 134.22MB
By signing below, I certify the information I have provided on the form is true and accurate. I agree to provide additional documentation to Club K After School Zone to verify financial need at any time during the application process or while on financial assistance. I also agree to notify Club K After School Zone of any changes in my financial circumstances. In order to continue receiving scholarship funds my account with Club K must be current at all times. Failure to maintain my account in good standing will result in the forfeiture of any scholarship funds going forward. I understand I must reapply annually for scholarships.