EmailMe Form - Kidstock! Scholarship Request Form

Student Name: *

Current Grade *

Student's Birthday *

MM / DD / YYYY

Please select the option that best fits your child:

has attended a Kidstock! program.

has a sibling who has attended a Kidstock! program.

has never attended a Kidstock! porgram.

Parent Name *

Email *

Cell Phone *

### - ### - ####

Mailing Address *

Street Address City State / Province / Region Postal / Zip Code

What SESSION are you requesting financial assistance for? *

SPRINGSTAGE 2025

SUMMERSTAGE 2025

The NUMBER of weeks I am interested in *

ONE week

TWO weeks

MULTIPLE weeks

The SPECIFIC weeks I am interested in (please select all that apply) *

The CLASS I am requesting financial assistance for *

The DAY(s) I am interested in (please select all that apply) *

Please indicate your requested tuition cost *

Please enter the dollar amount you could easily afford for the program you'd like to participate in. We need this information in order to create scholarship awards. Scholarshiped tuition is nonrefundable.

All requests for assistance greater than 50% of tuition require supporting tax documents be submitted.

Please explain briefly the circumstances surrounding your request for financial assistance: *

You may be asked to support your circumstances with a letter or tax return.

Is there an appropriate skill, task or talent you would be able to offer in exchange for tuition assistance? *

We often invite parents with a unique hobby, skill or talent to join us after hours during our extended day program to be a guest activity leader.