SCHOLARSHIP | Rogers Activity

Scholarship Application

I understand: This application must be completed in entirety. You must attach most recent two paystubs for all household members (over 18), the most recent 1040 tax return. Incomplete applications will result in AUTOMATIC DISQUALIFICATION. Contact the RAC to check on the application status. Program registration and membership is still required after application process.

Guardian's Name

Phone

Have you received a scholarship before?

YES

What program are you needing assistance with?

After School Care

Summer Day Camp

Youth Sports

Tell us why you need a scholarship.

Child's Name

Date of Birth

Program Requested

2nd Child's Name

2nd Child's Date of Birth

Program Requested

3rd Child's Name

3rd Child's Date of Birth

Program Requested

1st Adult's Name

1st Adult's Age

Most Recent Two Pay Stubs

Upload File

1st Adult's Relation to Child

1st Adult's Monthly Income

Most Recent 1040

Upload File

2nd Adult's Name

2nd Adult's Age

Most Recent Two Pay Stubs

Upload File

2nd Adult's Relation to Child

2nd Adult's Monthly Income

Most Recent 1040

Upload File

3rd Adult's Name

3rd Adult's Age

Most Recent Two Pay Stubs

Upload File

3rd Adult's Relation to Child

3rd Adult's Monthly Income

Most Recent 1040

Upload File

Additional Files If Needed

Upload File

Additional Files If Needed

Upload File

Additional Files If Needed

Upload File

Additional Files If Needed

Upload File

Your scholarship application has been approved.

Please allow 3-5 business days for review.