Financial Assistance Application

Honey Grove: Financial Assistance Application

Below are the standards we go off for financial assistance. Please view below before applying.

FSSA: HIP: Federal Poverty Level Income Chart

Please have the following ready:

Two of your most recent pay stubs
Your most recent tax form

Child #1*

First Name

Last Name

Do you need to add another child?*

Yes No

Child #2*

First Name

Last Name

Do you need to add another child?*

Yes No

Child #3*

First Name

Last Name

Which school district does your child(ren) attend?*

Center Grove Schools Clark Pleasant Schools

Which school does your child(ren) attend?*

Please select which option best applies:*

My child(ren) are already enrolled in the program. I want to see if I qualify. I want to see if I qualify before registering.

Other:

Below, please list names of all living in your household (including yourself)*

Total # of people living in your household that YOU are finanical responsible for.*

Total monthly income:*

Primary Parent/ Legal Guardian*

First Name

Last Name

Primary Email*

Phone Number*

Secondary Parent/ Legal Guardian

First Name

Last Name

Secondary Email

Secondary Phone Number

Recent pay stub #1*

No File Chosen

File uploads may not work on some mobile devices.

Recent pay stub #2*

No File Chosen

File uploads may not work on some mobile devices.

Most recent tax form*

No File Chosen

File uploads may not work on some mobile devices.

1. Financial assistance applications will be reviewed within two business days upon submitting. Approvals will be sent out via email.

2. A $30.00 (single) or $50.00 (multiple) child registration fee will be required.

3. Assistance does not apply to intermission and summer camp rates.

Signature*

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Use your mouse or finger to draw your signature above