Scholarship Assistance Application

Scholarship Guidelines

Scholarships are granted separately for summer and school year. Applicants must reapply.
Scholarships are limited to available funds.
All requests are reviewed objectively and confidentially.
Certain financial documents are required as part of the application.

The following factors will be reviewed when evaluating the application:

The financial resources of the application, including any special circumstances.
The degree to which the applicant has used his/her own resources to pay for the cost of services.
Degree and quantity of assistance requested from Girls Inc. in the past calendar year.

Child's Name:(Required)

First Last

Parent/Guardian's Name:(Required)

First Last

Address(Required)

Street Address Address Line 2 City State ZIP Code

Preferred Phone Number:(Required)

List all family members living in the household and age:(Required)

All adults living in the household that are employed must be included on the scholarship application, documentation is required (last 2 check stubs are required).

Adult Name:(Required)

First Last

Employer:

Employer Address:

Street Address Address Line 2 City State ZIP Code

Employer Phone:

Adult Name:

First Last

Employer:

Employer Address:

Street Address Address Line 2 City State ZIP Code

Employer Phone:

Have you received assistance from Girls Inc. of Wayne County previously?(Required)

Yes

When?(Required)

Briefly describe why you are applying for assistance?(Required)

Are there any special circumstances that should be noted when reviewing the application?

(medical bills, unemployment, garnished wages, or child support? If so, how much are you paying each month.)

Yes

Do you receive AFDC, TANF, Disability Insurance?(Required)

Yes

List Here:(Required)

What is your annual gross income before taxes or what is your hourly rate/average hours you work weekly?(Required)

What dollar amount do you deem able to pay?

Per month during school year or per week during summer

You must provide a copy of the following documents:

Photo ID (all adults in the household)
Social Security Cards for everyone
Last Year's Tax Return
Last Two Paycheck Stubs from employer
SSI Allocation Letter
Any other documents such as: AFDC, TANF, disability insurance, medical bills, unemployment, garnishment of wages, child support

Signature(Required)

Date(Required)

Testimonials

I wasn't born in Richmond and I had a hard time making friends; Girls Inc. enable me to make friends. Girls Inc. has really helped my life and I really enjoyed going there for plenty of reasons. I feel bad because this is my last year and I wish I could continue to come or at least work there. Girls Inc. and their staff mean a lot to me.
JaMarie

Bold is my word because I do try my hardest, I am outgoing, I love kids and people in general, I get involved with new activities and complete my tasks. It takes being strong and smart to become a bold outspoken young woman and I plan on being the same bold (sort) of person for the rest of my life. Thanks to Girls Inc. I can be.
Naomi

My favorite thing about Girls Inc. was the way (my girls) talked about it at the end of the day, full of stories about what they learned and did.
Parent