Registration

	Student's First Name: *	Last Name: *
	Student Gender: *	Birth Date: * (format=mm/dd/yyyy)
	Student Email:
	Grade Level:*
	Disabilities :
	Allergies :
	Medications (Leave blank if NONE):
	Use of photo allowed?:*
	Student May Be Released To?:*
	Public Transportation Allowed?:*
	Permission to give Medication:*
	Student sign themself In/Out?:*

	Student's First Name: *	Last Name: *
	Student Gender: *	Birth Date: * (format=mm/dd/yyyy)

	Student Email:
	Grade Level:*
	Disabilities :
	Allergies :
	Medications (Leave blank if NONE):
	Use of photo allowed?:*
	Student May Be Released To?:*
	Public Transportation Allowed?:*
	Permission to give Medication:*
	Student sign themself In/Out?:*

	Student's First Name: *	Last Name: *
	Student Gender: *	Birth Date: * (format=mm/dd/yyyy)

	Student Email:
	Grade Level:*
	Disabilities :
	Allergies :
	Medications (Leave blank if NONE):
	Use of photo allowed?:*
	Student May Be Released To?:*
	Public Transportation Allowed?:*
	Permission to give Medication:*
	Student sign themself In/Out?:*

	Student's First Name: *	Last Name: *
	Student Gender: *	Birth Date: * (format=mm/dd/yyyy)

	Student Email:
	Grade Level:*
	Disabilities :
	Allergies :
	Medications (Leave blank if NONE):
	Use of photo allowed?:*
	Student May Be Released To?:*
	Public Transportation Allowed?:*
	Permission to give Medication:*
	Student sign themself In/Out?:*

	Student's First Name: *	Last Name: *
	Student Gender: *	Birth Date: * (format=mm/dd/yyyy)

	Student Email:
	Grade Level:*
	Disabilities :
	Allergies :
	Medications (Leave blank if NONE):
	Use of photo allowed?:*
	Student May Be Released To?:*
	Public Transportation Allowed?:*
	Permission to give Medication:*
	Student sign themself In/Out?:*

I understand that my application for Financial Aid will not be processed until I submit proof of income. I will not submit this application until I have my documents ready to provide proof income. I understand that I can not submit a picture as proof of income.

Eligibility Documents to be submitted:
-Copy of W2 or 1040 Federal Tax Form for each adult living in the home , if 1040 has not been filed the following can be accepted: Check & Savings account statements for previous 1 month, Worker's compensation for previous 1 month, proof of unemployment benefits for previous 1 month, copy of divorce decree including alimony and child support amounts
-Two recent pay stubs
-Or Copies of awards letter for SSI, county assistance and child support.
-A letter explaining any extenuating circumstances of which we should be aware.
Those who cannot provide any documentation of income will not be considered for assistance.

Applicants for the youth scholarship program must be Philadelphia residents under the age of 18. Financial assistance is awarded without regard of race, color, religion, age, disability, or national origin of the applicant.

Financial assistance awarded is based on the family's need and availability of the Youth Scholarship Program Funds. Scholarship amounts awarded will be between 10% - 50% of the program fees. Scholarship recipients are responsible for paying the remaining balance owed.

If approved for Financial Aid Living Arts Dance Foundation Scholarship Low-Income Family Rates:
Registration $55.00 includes uniform & shoes
-2 Classes per week= $150.00 per month

Children can begin participating in a Living Arts, Inc. programs once the Youth Scholarship has been awarded and any co-pay fees and registration fees have been received.

To have your application processed you must submit the application documents.
You may email them to info@livingartsdance.com,
Fax to 888.294.9989
Mail or Schedule a time to drop off a copy of forms to our dance studios:
Living Arts Dance, Inc.
Attention: Living Arts Dance Foundation
624 N. Front Street, 2nd & 3rd Floor
Philadelphia, PA 19123

If you qualify for assistance, you will be required to report changes in your circumstances to the program director. Types of changes would include people leaving or moving out of the home, if someone loses a job, birth of a child, new sources of income or changes to income. Failure to report required changes within the program guidelines can result in a loss of assistance and jeopardize future eligibility.

We will keep your information private. It will only be used to decide which programs you may be eligible for.

We will give you a written notice describing your financial assistance or scholarship. Financial assistance or scholarships can be terminated at any time due to: students poor attendance, students behavioral problems, poor academic grades, lack of tuition co-pay.

I certify that all supporting documents are true and complete to the best of my knowledge. I understand that I may lose my assistance for lack of payment or falsifying information in connection with this application. I understand that I must bring documentation in every new session to qualify for the Financial/Assistance Scholarship Rate.