PAL Youth Scholarship Program
PAL Youth Scholarship Program The Flagler Sheriff’s PAL is proud to offer a Scholarship program for children in Flagler County. PAL has obtained funds for the purpose of granting children of low income families a chance to participate in programs. If you have a child who would qualify under the guidelines below, and would like to register for a program sponsored by PAL, simply fill out the application and return it to the PAL office with verification of your household income. All information is confidential. Our main objective is to provide all children in our community an opportunity to participate. If you have any questions, please call 386-586-2655. 1. Children may qualify for one program per season. 2. Need is the primary criteria upon which scholarships are considered. Accepted participants are expected to pay at least 50% of the registration fee. No full scholarships will be awarded. 3. Financial assistance reduces program fees, but it does not eliminate them. 4. Financial assistance will be awarded on a first come, first serve basis and will be subject to available resources. 5. This scholarship program provides assistance to youths from low income families who are not currently being served by existing scholarship or fee waiver programs. 6. PAL reserves the right to limit the amount of scholarships awarded to a household. No individual will be awarded more than $200 per calendar year. Eligibility To be eligible for a scholarship, a child must: Meet each of the criteria listed below: o o o o
Live in Flagler County Be enrolled in school (kindergarten through 12th grade) Commit to attend a minimum of 80% of scheduled practices and games Not be currently served by an existing scholarship or fee waiver program
For children of legal guardians, the court order establishing legal guardianship must be provided. Only those 17 years and under are eligible for scholarship assistance. Proof of income- All applicants must show proof of income, such as most recent income tax return, last four (4) payroll stubs, or letter from the appropriate social service agency. Application Process Complete the Scholarship Application Form (one form per child per activity please). All information must be supplied. Incomplete forms will not be considered. Applications and attachments should be submitted in person to: Flagler Sheriff’s Police Athletic League 160 Cypress Point Parkway Suite C217 Palm Coast, FL 32164
PAL Youth Scholarship Program A separate scholarship application form must be submitted for each child, and individual applications should be submitted a minimum of two weeks prior to the requested program’s start date.
PARTICIPANT INFORMATION Name: __________________________________________
Age: ________________________
Address: _____________________________________________________________________________ City: _____________________State: _______Zip:_______________ PROGRAM REQUESTED: ____________________________________________________________ PARENT/ LEGAL GUARDIAN INFORMATION Father’s or Legal Guardian Name: __________________________________Phone:_________________ Mother’s or Legal Guardian Name: ________________________________Phone:__________________ Email: _______________________________________________________________________________ Number of household members UNDER 18 years of age: ____ Number of members OVER 18 years of age: _______ INCOME INFORMATION Please check:
*Proof of ALL household income (Ex. - Previous year W-2, last 4 pay stubs, any other type of income to include local, state or federal assistance, child care assistance, food stamps etc.)
*Proof of county residency (Utility Bill)
Please give a brief statement of reasons for applying for assistance:
Have you received a PAL Scholarship in the past? ____________________ If so, when? _____________
I/We, the undersigned, understand that the information given will be kept confidential. The information provided is true and complete to the best of my knowledge and belief. I consent to the disclosure of such information for purposes of income and verification related to my/our application for financial assistance. I understand that any misrepresentations on this form will be grounds for disqualification. I agree to pay any outstanding balance I have on my household account after all scholarship money has been applied. ______________________________________________ Parent/ Legal Guardian Signature
_______________________________ Date
Internal Use Only Date Received________ Date Reviewed_______ Approval/Denial________ Amount Awarded_______
Live in Flagler County Be enrolled in school (kindergarten through 12th grade) Commit to attend a minimum of 80% of scheduled practices and games Not be currently served by an existing scholarship or fee waiver program
For children of legal guardians, the court order establishing legal guardianship must be provided. Only those 17 years and under are eligible for scholarship assistance. Proof of income- All applicants must show proof of income, such as most recent income tax return, last four (4) payroll stubs, or letter from the appropriate social service agency. Application Process Complete the Scholarship Application Form (one form per child per activity please). All information must be supplied. Incomplete forms will not be considered. Applications and attachments should be submitted in person to: Flagler Sheriff’s Police Athletic League 160 Cypress Point Parkway Suite C217 Palm Coast, FL 32164
PAL Youth Scholarship Program A separate scholarship application form must be submitted for each child, and individual applications should be submitted a minimum of two weeks prior to the requested program’s start date.
PARTICIPANT INFORMATION Name: __________________________________________
Age: ________________________
Address: _____________________________________________________________________________ City: _____________________State: _______Zip:_______________ PROGRAM REQUESTED: ____________________________________________________________ PARENT/ LEGAL GUARDIAN INFORMATION Father’s or Legal Guardian Name: __________________________________Phone:_________________ Mother’s or Legal Guardian Name: ________________________________Phone:__________________ Email: _______________________________________________________________________________ Number of household members UNDER 18 years of age: ____ Number of members OVER 18 years of age: _______ INCOME INFORMATION Please check:
*Proof of ALL household income (Ex. - Previous year W-2, last 4 pay stubs, any other type of income to include local, state or federal assistance, child care assistance, food stamps etc.)
*Proof of county residency (Utility Bill)
Please give a brief statement of reasons for applying for assistance:
Have you received a PAL Scholarship in the past? ____________________ If so, when? _____________
I/We, the undersigned, understand that the information given will be kept confidential. The information provided is true and complete to the best of my knowledge and belief. I consent to the disclosure of such information for purposes of income and verification related to my/our application for financial assistance. I understand that any misrepresentations on this form will be grounds for disqualification. I agree to pay any outstanding balance I have on my household account after all scholarship money has been applied. ______________________________________________ Parent/ Legal Guardian Signature
_______________________________ Date
Internal Use Only Date Received________ Date Reviewed_______ Approval/Denial________ Amount Awarded_______
