Please complete application if you are unable to pay for a program at the Agriplex.  Our Board and staff would like our programs to be available to all.  Applications must be completed at least 1 week before desired program to qualify for a scholarship.  Scholarships will be evaluated on need basis and on availability of spaces.
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Email *
Participant Name, First and Last *
Guardian Name of Participant if under 18 *
Address of Participant *
E-mail of Contact *
Phone Number *
Participant Age *
How many adults are in your household? *
How many children are in your household? *
Household assistance: check all that apply. *
What is your ENTIRE household income from ALL persons earning or receiving income: *
For which program would you like to register? *
Please list names and ages of participants to register? *
Since the North Alabama Agriplex is a non-profit, we  have limited scholarships available. Why should we select you for this fee waiver? *
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