AYS Financial Assistance Application - Updated

Have you submitted your AYS enrollment?*

Yes No

STOP! You must enroll your family in AYS before you can apply for assistance. Applications submitted without an enrollment will not be processed. Please click here to register your child.

Parent's Name*

First Name

Last Name

Have you applied for CCDF?

Yes No

STOP! You must apply for CCDF before you can apply for assistance. Applications submitted without a screen shot showing proof that you have applied for CCDF, will not be processed. Please click here to apply for CCDF.

Which option below applies to you?

I have applied for CCDF and have been wait listed or denied I receive OMW Pre-K vouchers and have been denied a wrap-around voucher I am registered for the AYS Scholar’s program

Please enter the date you applied for CCDF

Please enter the date you applied for a wrap-around voucher

Please upload a photo of your denial or wait list notification

No File Chosen

File uploads may not work on some mobile devices.

Please upload a photo of your denial of the wrap-around voucher

No File Chosen

File uploads may not work on some mobile devices.

Does your child receive free or reduced lunch?*

Yes No

This application is for*

School Year Summer Days

Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Phone*

Email*

Upload a copy of your photo ID*

No File Chosen

File uploads may not work on some mobile devices.

Photo ID must be present or application will not be processed.

Child Attending AYS*

First Name

Last Name

Child's Date of Birth

Select School District*

Select School*

Select School *

Add second child attending AYS

Add child

Child Attending AYS*

First Name

Last Name

Child's Date of Birth

Select School District*

Select School*

Add third child attending AYS

Add child

Child Attending AYS*

First Name

Last Name

Child's Date of Birth

Select School District*

Select School*

Total Number of Adults in the Household*

Total Number of Children in the Household*

Total Number of People in the Household

Is there an adult in your household who is working?*

Yes No

Name of Working Adult*

First Name

Last Name

Hours Worked per Week*

30 Days Gross Income* $

Child Support* $

SSI/Disability* $

Other Income* $

Total Income $

Upload 30 days of your most recent pay stubs*

No File Chosen

File uploads may not work on some mobile devices.

Pay-stub must be present or application will not be processed.

Upload 30 days of your most recent pay stubs

No File Chosen

File uploads may not work on some mobile devices.

Use this field if you have multiple files to upload.

Upload 30 days of your most recent pay stubs

No File Chosen

File uploads may not work on some mobile devices.

Use this field if you have multiple files to upload.

Upload 30 days of your most recent paystubs

No File Chosen

File uploads may not work on some mobile devices.

Use this field if you have multiple files to upload.

Is there a second adult in your household that is working?

Add

Name of Working Adult*

First Name

Last Name

Hours Worked per Week*

30 Days Gross Income* $

Child Support* $

SSI/Disability* $

Other Income* $

Total Income $

Upload 30 days of your most recent pay stubs*

No File Chosen

File uploads may not work on some mobile devices.

Pay-stub must be present or application will not be processed.

Upload 30 days of your most recent pay stubs

No File Chosen

File uploads may not work on some mobile devices.

Use this field if you have multiple files to upload.

Upload 30 days of your most recent pay stubs

No File Chosen

File uploads may not work on some mobile devices.

Use this field if you have multiple files to upload.

Upload 30 days of your most recent pay stubs

No File Chosen

File uploads may not work on some mobile devices.

Use this field if you have multiple files to upload.

Is there a third adult in your household that is working?

Add

Name of Working Adult*

First Name

Last Name

Hours Worked per Week*

30 Days Gross Income* $

Child Support* $

SSI/Disability* $

Other Income* $

Total Income $

Upload 30 days of your most recent pay stubs*

No File Chosen

File uploads may not work on some mobile devices.

Pay-stub must be present or application will not be processed.

Upload 30 days of your most recent pay stubs

No File Chosen

File uploads may not work on some mobile devices.

Use this field if you have multiple files to upload.

Upload 30 days of your most recent pay stubs

No File Chosen

File uploads may not work on some mobile devices.

Use this field if you have multiple files to upload.

Upload 30 days of your most recent pay stubs

No File Chosen

File uploads may not work on some mobile devices.

Use this field if you have multiple files to upload.

Add Adult Attending School

Add

Name of Adult Attending School*

First Name

Last Name

Name of School*

Hours Enrolled *

Study Hours per Week*

Please upload a copy of your school schedule.*

No File Chosen

File uploads may not work on some mobile devices.

Add Adult Attending School

Add

Name of Adult Attending School*

First Name

Last Name

Name of School*

Hours Enrolled *

Study Hours per Week*

Please upload a copy of your school schedule.*

No File Chosen

File uploads may not work on some mobile devices.

I understand that an incomplete application will not be processed. It is not the responsibility of AYS to obtain missing information.*

I understand

I understand that financial assistance is not guaranteed and I agree to pay full weekly tuition rates each Friday until a financial assistance decision has been made. *

I agree

I understand that if I am awarded financial assistance, I am required to make weekly co-payments no later than Friday for the upcoming week. Failure to do so will result in the loss of financial assistance.*

I understand

By signing below, I certify that the information provided above is true and complete to the best of my knowledge.

Applicant Signature*

[clear]

Use your mouse or finger to draw your signature above

Today's Date*

Dropdown List

AYS Financial Assistance Application - Summer & School Year