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.

How the Scholarship Process Works

• Applications are reviewed confidentially by Foundation Scholarship Committee
• Awards are based on financial need and available funds
• Scholarships typically cover partial tuition only
• Approved scholarships apply only to the selected semester

Applicant Information

Participant Name: ______________________________________

Date of Birth: _________________________________________

Parent/Guardian Name(s): _______________________________

Address: ______________________________________________

Phone Number: ________________________________________

Email Address: _________________________________________

Enrollment Information

☐ New Applicant  ☐ Currently Enrolled

Semester Applying For:

☐Spring                 ☐Summer                 ☐Fall

Scheduled Day(s):
☐ Monday ☐ Tuesday ☐ Wednesday ☐ Thursday.

Requested Level of Support (if applicable):

☐ 1:1                 ☐ Small Group         ☐ Not Sure

Household Financial Information

Household Size: ______

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.

Statement of Financial Need

Please briefly explain your family’s financial circumstances and why scholarship assistance is being requested:

Example(s) include:

• Any current financial challenges your family is facing
• Any recent changes in income or expenses
• How scholarship assistance would impact your ability to participate

Required Documentation (attach copies)

☐ Proof of household income (pay stubs, benefit letters, etc.)
☐ SSI/SSDI award letter (if applicable)
☐ Current enrollment agreement (if currently enrolled)

Incomplete applications cannot be reviewed until all documents are received.

Scholarship Participation Agreement

Families receiving scholarship support are encouraged to partner with The Chadwick Foundation in sustaining scholarship opportunities for others. This may include:

• Volunteering at a Chadwick Foundation event
• Helping connect the Foundation with potential donors or sponsors

If participation is not possible due to personal circumstances, we will work with your family to identify other meaningful ways to stay connected.

Acknowledgment & Agreement

By signing below, I acknowledge and understand that:

•  I understand that scholarships are limited and not guaranteed\
• I understand awards are based on available funds
• I understand this is partial tuition assistance only
• I understand this award applies only to the selected semester
• I understand I must reapply each semester
• I agree to follow all program policies and attendance expectations

Parent/Guardian Signature: _______________________________

Date: _________________________________________________

☐ I am open to sharing my family’s story (anonymously or publicly) to help support future scholarship funding.

Submit completed applications to:
The Chadwick Foundation
PO Box 105
Cloverdale, AL 35617

Applications are reviewed confidentially by Foundation leadership & Scholarship Committee. Families will be notified once a determination has been made.