Application for Danzante Summer Camp Scholarship
Today’s Date______________
Through its fundraising efforts Danzante is able to provide a limited number of scholarships to enable children to
attend programs at a reduced fee. Applications are evaluated according to need. Willingness and ability to
volunteer with the Danzante Program will be used in determining eligibility for scholarship. Information must be
truthful and applications will be accepted during program registration periods. The Danzante Board of Directors
selects the scholarship recipients. Applications are valid for the duration of the program in which your child is
registered for. All information is confidential.
Name of child or children__________________________________ Date of Birth___________________
Address_____________________________________________________________________________
School_____________________________________________Grade____________________________
Names and ages of other children living in the household:
1.______________________________________ 2. __________________________________________
3.______________________________________ 4. __________________________________________
5._____________________________________ 6.__________________________________________
Name of Parent(s)
Guardian(s):_____________________________________________________________
Home Address_________________________________________________________________________
Day phone:______________________ Evening Phone:_________________________________________
Name and address of Employer(s):_________________________________________________________
Hours worked per week:________________
Salary: $_________ Circle one:
Hourly
Weekly
Bi-Weekly
Yearly
Other_____________
If you receive a scholarship, are you able to pay the minimum of $300 for Harrisburg School District
Students/current afterschool students or $600 for non-Harrisburg School District Students? YES/NO
If you receive a scholarship will you agree to Danzante attendance and behavior policies with your child? Yes/No
Have you at any time received any other scholarships from Danzante for any of your children? Yes/No
Is there other information you would like to share? Yes/No (If yes please explain on back of this form)
I agree that the information provided on this form is truthful and accurate. I authorize Danzante to verify
information.
____________________________________________
__________________________
Signature of Parent/Guardian
Date
Tuition fee determined by Danzante Director and agreed to by Parent/Guardian $__________
__________________________________________________
Signature of the Director
DANZANTE Community Art Center
200 Crescent St. Harrisburg, PA 17104
OFFICE:
717-232-2615
www.danzante.org