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Children & Youth Activity
SCHOLARSHIP APPLICATION

Instructions:
Following submission of the application, we will contact you by phone or email. This is not a registration form. Please wait to register your child(ren) for the event/activity until after you have heard from us. If you have questions, email Kelsey Bacon at kbacon@ualc.org.

Household Information:

Please provide the following information for your household.

Parent /Guardian Name: *

Spouse's Name:

Today's Date: * +

Address: *

City: *

State: *

Zip Code: *

Home Phone #: *

Cell Phone #: *

Work Phone #:

Extension:

Best way to contact you: *

Email Address: *

Church Affiliation: *

Other: *

UALC Worship Community Style: *

Family Information:

Please provide the following information for all children under 18.

#1. Child’s Name: *

#1. Birthdate: * +

#1. School Name: *

#1. Grade: *

Another Child? *

Yes

#2. Child’s Name: *

#2. Birthdate: * +

#2. School Name: *

#2. Grade: *

Another Child? *

Yes

#3. Child’s Name: *

#3. Birthdate: * +

#3. School Name: *

#3. Grade: *

Another Child? *

Yes

#4. Child’s Name: *

#4. Birthdate: * +

#4. School Name: *

#4. Grade: *

Scholarship Recipient(s) Information:

Please list the child(ren) for whom you are requesting scholarship(s).

#1. Recipient Name: *

#1. UALC Activity: *

#1. Tuition Total: *

#1. Amt Requested •: *

Another Recipient? *

Yes

#2. Recipient Name: *

#2. UALC Activity: *

#2. Tuition Total: *

#2. Amt Requested •: *

Another Recipient? *

Yes

#3. Recipient Name: *

#3. UALC Activity: *

#3. Tuition Total: *

#3. Amt Requested •: *

• The maximum scholarship awarded is 50% Tuition Total for events/activities. However, scholarship awards are based on many factors including the number of requests, each family situation, and UALC budget constraints. We may not be able to accommodate all scholarship requests.

Additional Information:

What is your relationship to UALC: *

Why do you want your child to attend this event/activity? *

Please provide any other information you feel would be helpful for the Scholarship Team to know about your child/teen, you or your current life situation.

0/300 words

Have you received UALC scholarships or material assistance in the past? *

Yes

We may be able to set up a payment plan. Please indicate the amount you are able to pay: *

$25/month

$50/month

$100/month