Chadwick Foundation Family Respite & Academy Scholarship
The Chadwick Foundation Academy offers limited, need-based scholarship assistance when funds are available. The purpose of this program is to support families experiencing financial hardship while ensuring the long-term sustainability of Academy services.
Scholarships are not guaranteed, are not automatic, and are awarded on a semester-by-semester basis depending on available funds.
Participant Name: ______________________________________
Date of Birth: _________________________________________
Parent/Guardian Name(s): _______________________________
Address: ______________________________________________
Phone Number: ________________________________________
Email Address: _________________________________________
☐ New Applicant ☐ Currently Enrolled
Semester Applying For: _________________________________
Scheduled Days (circle all that apply):
Tuesday Wednesday Thursday
Total Monthly Household Income (approximate):
$ _______________________
(Includes parent/guardian income, wages, benefits, recurring support, and other household income.)
Does the participant receive benefits?
☐ Yes ☐ No
If yes, please list type (SSI, SSDI, etc.):
Important Notice:
Scholarship determinations are not based solely on the participant’s income. Parent or legal guardian income is considered when reviewing all scholarship applications in order to make fair and responsible funding decisions.
Please briefly explain your family’s financial circumstances and why scholarship assistance is being requested:
☐ Proof of household income (pay stubs, benefit letters, etc.)
☐ SSI/SSDI award letter (if applicable)
☐ Current enrollment agreement (if currently enrolled)
Incomplete applications may delay review.
Families receiving scholarship assistance are asked to support the mission of the Chadwick Foundation through community partnership.
This may include:
☐ Volunteering at at least one Chadwick Foundation community event during the semester
OR
☐ Assisting in identifying or helping secure a donor or sponsorship contribution to the Academy Scholarship Program
Participation helps ensure scholarship funds remain available for future families. If a family is unable to meet this expectation due to scheduling or personal circumstances, alternative arrangements may be discussed with Foundation leadership.
By signing below, I acknowledge and understand that:
• Scholarship assistance is limited and not guaranteed
• Awards are based on available scholarship funds
• Scholarships provide partial tuition assistance only
• Assistance applies only to the semester listed
• Scholarship approval does not guarantee future funding
• Continued assistance requires reapplication each semester
• Attendance and program policies must be followed
Parent/Guardian Signature: _______________________________
Date: _________________________________________________
Submit completed applications to:
The Chadwick Foundation
PO Box 105
Cloverdale, AL 35617
Applications are reviewed confidentially by Foundation leadership. Families will be notified once a determination has been made.