Program Financial Assistance Application

Kalamazoo Nature Center – Program Financial Assistance Application

(TO BE COMPLETED BY PARENT/GUARDIAN) ONE FORM MAY BE COMPLETED PER FAMILY EACH YEAR **THE CONTENTS OF THIS FORM WILL REMAIN CONFIDENTIAL**

Parent/Guardian Name: *

First and Last Name

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Requested aid for:

Camp

Nature’s Way Preschool

Other ProgramOther Program

Number of people (dependents or other) living at listed residence:

Annual Household Income (includes alimony, disability, etc.)

Applicant Employer

Phone

Spouse Employer

Phone

Number of Child(ren) Attending Program

Income Verification

Maximum file size: 134.22MB

Please submit income verification with this application in the form of last year’s tax return summary, W-2, SSA benefit summary, or other similar documentation. Applicant will be notified by email of award decision.

Applicant Signature

Clear

By signing above, I agree that all information provided is complete and accurate to the best of my knowledge.

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