Boys & Girls Club of East Providence FInancial Assistance Application

What program are you applying for a scholarship for? *

Household Information

Parent First Name *

Parent Last Name *

E-mail Address *

Please list ONLY the children who you are requesting a scholarship for below.

If you have other children that are not participating in a Boys & Girls Club Program you do not need to enter their information but should include them when entering Household Size information.

If you have more than 4 children that you are requesting scholarships for, please enter any additional children's information in reason for request section below.

Child's First Name *

Child's Last Name *

Child's age *

Current Grade *

Child's First Name

Child's Last Name

Child's age

Current Grade

Child's First Name

Child's Last Name

Child's age

Current Grade

Child's First Name

Child's Last Name

Child's age

Current Grade

Address 1 *

Address 2

Phone *

Email Address *

City *

State *

Zip Code *

How many people (adults and children) live in your household? *

What is your annual household income? Please include all forms of income including wages earned, child support and government benefits? *

Please briefly describe the reason for your request *