Registration
Living Arts Dance Foundation is a nonprofit corporation that administers financial assistance to eligible youth. Financial Eligibility Documents to be submitted: Copy of 1040 Federal Tax Form for each adult living in the home or Two recent pay stubs, 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 documentation of income will not be considered for assistance.
Event:
Start Date/Time: End Date/Time:
Fee per Family: Room:
* - denotes required fields
Family Information
First Name:* Last Name: *
Type*
Home Phone: Cell #: Work #:
Email:* (Emails are kept confidential)
 
Address: *
City: * State: * Zip: *
Emergency Contact Info
(Not Contact #1 or #2)*
 
 
 
Questions/Options:
Student Name & age*
Student Address*
Student Birth Date*
Student Cell Phone Number
Total # living in the household, please list names and ages*
Parent Marital Status*
Name of School Student is currently attending*
School Telephone Number
Does your household receive government assistance? If yes, please describe*
Please provide any additional information that you think might help us in making a determination.
 
Additional Information:
 
Eligibility Documents
Eligibility Documents to be submitted:
-Copy of 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 documentation of income will not be considered for assistance.
I've read the above and agree.
 
Eligibility for Financial 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.
I've read the above and agree.
 
What amount of assistance is available?
Financial assistance awarded is based on the family's need and availability of the Youth Scholarship Program Funds. Scholarship amounts awarded will be between 50% - 90% of the program fees. Scholarship recipients are responsible for paying the remaining balance owed.
I've read the above and agree.
 
When can my child begin classes?
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.
I've read the above and agree.
 
Where do I turn in my scholarship documents?
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 Drop off a copy of forms to our dance studios:
Living Arts Dance, Inc.
Attention: Living Arts Dance Foundation
81 Fairmount Avenue
Philadelphia, PA 19123
I've read the above and agree.
 
Responsibility to Report Changes
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.
I've read the above and agree.
 
Right To Confidentiality
We will keep your information private. It will only be used to decide which programs you may be eligible for.
I've read the above and agree.
 
Notice
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've read the above and agree.
 
Certify
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.
I've read the above and agree.
 
Enter your Full Name: *   
 
Other Questions/Comments: