2023-2024 Reduced Rate Scholarship
The reduced rate must be applied for each school year.  Approval of the reduced rate is good only for the academic year for which application is made.
This application should only be filled out:

      * AFTER your application for enrollment to the After School program has been 
        completed and submitted.            
      * For applicants to be considered, children must be enrolled for a minimum of 4 days 
         each week.
      * You MUST have applied and been denied for child care subsidy by the Watauga 
         County Department of Social Services (DSS) before you will be considered for this rate. 

For information on qualification see the Eligibility Standards document on the web page.

In addition to submission of this form please provide the following documentation to the Program Coordinator at your school or Program Director at the Central Office for all adults living within your household:

     * A copy of the DSS denial or waiting list letter showing your were denied or are 
        currently on the waiting list.
     * Your household's last tax statement showing line 37
     * Last paycheck stub/s for each adult in household
     * Student loan statement if applicable
     * Child support verification
     * Or any other documentation that supports verification of your household income or 
        listed as gross income on your tax document.

Not providing requested documentation and information will result in a delay of approval. Subsidy does not start until the day of approval. The date of application is automatically recorded when this application is submitted. You will be notified by e-mail of approval or denial.

To be eligible for the first day of the program April 1, 2023, this application and all documentation must be submitted on or before March 28, 2023.  All applications received after 4:30 p.m. on this date will be considered for the following month provided spaces are still available.  Since reduced rate scholarships are extremely limited, priority will be given to applicants applying for the most days of care and the youngest children needing care. Watauga Virtual Academy children are not eligible for the Reduced Rate Scholarship.

Privacy Act Statement
The confidentiality of the information on this application is protected by the "Right to Privacy Act (1974)".  This information will only be used to determine your eligibility for reduced rates for the after school program.
Sign in to Google to save your progress. Learn more
Valid Email *
Please fill in the child's first and last name in the space below.  If you have multiple children, you will need to fill out a form for each child.
 *
Please Select School *
Required
The reason I need child care is to help support me while I.....
Clear selection
How many people are there in your household?
 *
Please fill in the child's date of birth in the space below.
 *
MM
/
DD
/
YYYY
Are there special circumstances you would like us to consider?   (This could be situations like a child with special needs or that needs tutoring, an elderly care giver, or similar situations)
Please check the days of the week you have registered the child in after school (four days minimum)
 *
Required
Gross (before taxes) household income per month. Include all adults in your house hold.
 *
Does your child receive free and reduced lunch?
Clear selection
I certify that the information I have given on this application is correct. I authorize the Watauga County Department of Social Services to share my subsidy application information with the Watauga County Schools for the purpose of confirming the information on this application. I also authorize the Child Nutrition office of the Watauga County Schools to disclose to the after school program whether or not the children listed on this application receive a free or reduced price lunch.
Clear selection
By typing my name below I agree by legal electronic signature to the terms of this application. (Please type name including slash marks as indicated below). 

   /    First Name, Last Name     /        
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Watauga County Schools. Report Abuse
Google Forms