Youth Scholarship Application

This scholarship is available for youth, up to 18 years of age and/or through high school, unless the program is intended for disabled youth, in which case the program may serve youth no older than 20 years of age. The maximum funding level per child is $300 per fiscal year (July 1 – June 30) for summer camp activities and related support. The maximum amount for organized sports activities (team registration fees, school activity fees) is $100.

Name of Child

Age of Child

Date of Birth

Gender of Child

Parent/Guardian Name

Phone

Mailing Address

Street Address City State ZIP Code

Name of Program/Activity/Need

Total Cost

Program Beginning Date

Program Ending Date

Agency to Receive Funding

Agency Contact Person

Agency Phone

Agency Email

Agency Address

Street Address City State ZIP Code

Have you applied for funding from the program agency? If so, how much did you receive?

Does your child qualify for reduced or free lunch with the school district?

Yes

Is the child in OCS custody or a foster child?

Yes

Number of wage earners in household:

Number in household (including yourself)

Report all household income for the past 12 months from date of application

Gross Wages

Social Security Income

Unemployment

Public Assistance

Disability Benefits

Total Income

CAPTCHA

Zach Gordon Youth Services

A Division of Parks & Recreation

Physical Address:
396 Whittier St.
Juneau Alaska 99801

Telephone:

Parks & Recreation

155 Heritage Way - City Hall Rm 218
Juneau Alaska 99801

Telephone:

PARKS & RECREATION

Youth Scholarship Application

Report all household income for the past 12 months from date of application

Zach Gordon Youth Services

Parks & Recreation