Heldeberg Workshop Confidential Needs-based Scholarship Application
A maximum of two weeks tuition may be awarded per child.
Busing fees are included in full scholarships.
Please complete one application for all pertinent children and either
1) mail directly to Heldeberg Workshop, PO Box 323, Voorheesville, NY 12186
or 2) email it to our confidential email: email@example.com as soon as possible to ensure prompt consideration.
Name and DOB of the child: ____________________________________________________
Name and DOB of second child: _________________________________________________
Name and DOB of third child: ___________________________________________________
Name and DOB of fourth child: __________________________________________________
How much assistance are you applying for? Half______ Full________
1. Does the applicant(s) qualify for any kind of financial assistance at the school he or she attends (reduced lunch or free lunch)? Please describe here:
2. Do you or your family receive any financial aid or assistance? Please describe here:
3. What is the annual household income last reported to IRS? __________________
4. How many people are supported by that income? _________________________
5. How many children are in the household? _______________________________
6. Briefly describe why you are requesting this assistance:
7. Do you need transportation and if so, from which stop?
8: Home Address for mailing purposes:
By signing this form I certify that this information is correct to the best of my knowledge.
Signature: _______________________________________________________(type your name)
email to: firstname.lastname@example.org