Scholarship Application Form OVParks Youth Scholarship program Parent/Guardian Name (required) Address (required) Parent Email (required) Parent Phone Number (required) Scholarship Request Information Child #1 Name/Age/Grade (required) Program interested in child #1 (required) Child #2 Name/Age/Grade Program interested in child #2 Child #3 Name/Age/Grade Program interested in child #3 Child #4 Name/Age/Grade Program interested in Child #4 Child #5 Name/Age/Grade Program interested in child #5 Do you receive any form of Government Assistance? (ex: SNAP, Lifeline, Medi-Cal, WIC, CalWORKs, Energy Assistance programs) (required) Yes No If yes, please list government assistance program enrolled in Please mark yes if you understand that the scholarship will only cover 75% of program fees for one activity/program per year with up to a maximum of $200 per child ? (required) Yes No There was a problem saving your submission. Please try again later. Please wait while your submission is being saved... Submitting...Submit Thank you, your submission has been received.
