COPPERMINE SCHOLARSHIP APPLICATION

Develop - Inspire - Achieve

Coppermine accepts applications on a rolling basis and processes them in the order in which they are received. Families interested in applying for a scholarship must complete the application below. It is important that all sections are filled out completely. Please note that incomplete applications will not be accepted.

Scholarship Application
Application Status:

APPLICATION FOR:

Before/After School Enrichment (ages 5-14)
Youth Programming (ages 2-14)
Club Programming (ages 2-14)
Summer Camp (ages 4-18)
Summer Camp Weeks:

PARENT/GUARDIAN INFORMATION:

Name
Name
First
Last
Gender:
Check One

CHILD’S INFORMATION

Child's Name
Child's Name
First
Last
Child's Gender
Has your child attended Coppermine programming previously?

FINANCIAL INFORMATION

Do you currently get assistance through the county or other agency?
Please note, this does not guarantee you will receive the remaining balance, but it is a guide for us. Thank you.

COPPERMINE EXPERIENCE

SIGNATURE

The information I have provided on this form is complete and correct and I agree to provide additional documentation upon request to verify need of financial assistance. I understand that Coppermine provides financial assistance to the extent that resources are available and that Coppermine reserves the right to refuse assistance to any applicant. I also understand that my current Coppermine account must be in good standing prior to this application being processed.