Scholarship Application - University Of California Berkeley
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1UNIVERSITY OF CALIFORNIA, BERKELEY
UNIVERSITY VILLAGE RECREATION PROGRAMS
Youth Financial Assistance Application
DIRECTIONS/INFORMATION:
The University Village Recreation Program Office provides limited financial
assistance for children to participate in our programs. The amount of financial assistance available varies from partial to a
full scholarship. Financial assistance awards are based on financial need, merit and amount of monies available. Submit
the completed form to the University Village Recreation Office before the beginning of the programs first class.
Completion of this application is not a guarantee of participation because there are only a limited number of scholarships
available. All applications will be confidential. You will be notified by phone when a decision has been made.
Applications should be returned to: University Village Recreation Office 1125 Jackson Street Albany, CA 94706.
GENERAL INFORMATION ON CHILD
Child’s Full Name
DOB
Age
Grade
Address
Street Address
City
State
Zip
Parent(s) / Guardian(s) Full Name(s)
Main Telephone
Email
Child lives with
Mother
Father
Both
Guardian
# of Children at Home
Are you available for volunteer work?
Yes
No
If Yes, what days and times would you be available?
What skill or type of work can you do?
PROGRAM INFORMATION
Program Name
Day(s)
Time
Session #
Session Dates
ELIGIBILITY INFORMATION
Please submit the following documents to the Village Office to be considered for financial assistance.
Completed and Signed Financial Assistance Application
Completed and Signed Registration/Enrollment Form
Copies of statements and applications that can provide information to clarify financial need (i.e., W2 Forms, Bank Statements,
Financial Aid Letter, AFDC Award Letters, etc.)
Letter from parent or guardian explaining why you feel assistance is needed and how the child would benefit from the participation
in the program
FAMILY RECEIVES PUBLIC ASSISTANCE. Check off any and all applicable forms.
AFDC
Social Security
Disability
Unemployment
Other: ___________________________________________
Total Number in Family
Total Family Income
$
LOW INCOME.
Child support or additional income (must include ALL grants, fellowships, TA’s, Work Study or any additional income.
$
Mother’s / Guardian Occupation
Father’s / Guardian Occupation
I certify that the above information is correct.
Parent/Guardian Signature
Relationship to Child
Date
University Village Recreation Program – 1125 Jackson Street – Albany, CA 94706 – (510)524-4926
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