Gallo Center Youth Academy Scholarship Application

The Gallo Center Youth Academy is pleased to be able to offer financial assistance in the form of payment plans and discounted fees for participation in GCYA classes. Assistance is granted to families that demonstrate a need and who would otherwise be unable to participate in the program. Assistance is awarded on a sliding scale. To apply, please complete and submit the following form. Families with multiple children participating should submit a form for each child.

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* Contact Information

Student Name (First and Last)

Parent Name (First and Last)

Parent Email

Parent Phone Number

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* Please select the class in which you'd like to register your student:

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* Parent Employment and Financial Information

Parent #1 Occupation/Employer

Parent #1 Monthly Earnings

Parent #2 Occupation/Employer

Parent #2 Monthly Earnings

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* Please list all additional household income. Please include all sources: alimony or support from non-custodial parent, Veterans/Social Security benefits, unemployment or worker's compensation, federal or sate aid, etc.

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* Total number of people living in the household supported by the above income

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* Has your child participated in the Gallo Center Youth Academy before? If yes, how many times?

Yes

If yes, number of times

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* Has your child received a scholarship to participate in the Gallo Center Youth Academy before? If yes, how many times?

Yes

If yes, number of times

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* Please detail any additional information you'd like to share below.

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