Has your application been submitted? Before closing this window make sure that your application has been fully processed and that you landed on the Thank You page. 2020 - 2021 Preschool Scholarship Application PRINTABLE PDF Scholarship Application Child Information Date Full Name of Child Applying For * Gender --MaleFemale Date of Birth Age Address Address Address Line 1 Address Line 1 Address Line 2 Address Line 2 City City State AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State Zip Code Zip Code Number of persons in the household (include ages) Mother's Information Mothers Full Name Annual Income Phone Cell Text Work Text Home Email Father's Information Father's Full Name Annual Income Phone Cell Text Home Text Work Email Household Income Other Household Income: All income of individuals related to the child by blood or marriage must be listed including, but not limited to, current employment, child support, unemployment payments, etc. Type of Income Amount and Frequency plus1 Add Income minus1 Remove Income Proof of income is required. Provide most recent federal income tax return or most recent W2s. If you’ve had a change of income since your most recent tax return, submit 2 months of current paystubs If you’ve had a change of income since your most recent tax return, upload 2 months of current paystubs Drop a file here or click to upload Choose File Maximum file size: 104.86MB Additional Information Legal Guardian (if applicable) Name of Preschool you'd like your child to attend * Preschool Location * Which class/number of days per week * What is the total monthly cost for the desired preschool class? * How much, if any, can you afford for preschool each month? * Upon receipt of a scholarship, I/we commit to attending 6 parenting classes offered through Family Haven. Signature signature keyboard Clear Please allow 8-10 seconds after clicking submit for us to collect your application details before closing the browser window. If you are human, leave this field blank. Submit
