Heldeberg Workshop Confidential Needs-based Scholarship Application
A maximum of two weeks tuition may be awarded per child.  Busing fees are included in full scholarships.
Please complete one application for all pertinent children and either 1) mail directly to Heldeberg Workshop, PO Box 323, Voorheesville, NY  12186 or 2) email it to our confidential email: scholarship@heldebergworkshop.org as soon as possible to ensure prompt consideration. 

Name and DOB of the child: ____________________________________________________

Name and DOB of second child: _________________________________________________

Name and DOB of third child: ___________________________________________________

Name and DOB of fourth child: __________________________________________________

How much assistance are you applying for? Half______ Full________

 

 Financial Information
1. Does the applicant(s) qualify for any kind of financial assistance at the school he or she attends (reduced lunch or free lunch)? Please describe here:
_________________________________________________________________
2.  Do you or your family receive any financial aid or assistance?  Please describe here:
_________________________________________________________________
3. What is the annual household income last reported to IRS? __________________
4. How many people are supported by that income? _________________________
5. How many children are in the household? _______________________________

6. Briefly describe why you are requesting this assistance:
________________________________________________________________
________________________________________________________________
________________________________________________________________

7. Do you need transportation and if so, from which stop?
_________________________________________________________________

8: Home Address for mailing purposes:

________________________________________________________________
________________________________________________________________
________________________________________________________________


By signing this form I certify that this information is correct to the best of my knowledge.  
Signature: _______________________________________________________(type your name)
Date: ____________

email to: scholarship@heldebergworkshop.org