2020-2021 Medina Early Childhood PTA Diane E. Guenther Preschool Scholarship Application
Please complete the application in its entirety to be considered for the 2020-21 school year. All information will be kept strictly confidential within the selection committee.

To qualify for the preschool scholarship:
1. You must reside in Medina County.
2. You must be willing to provide verification of income, if selected.
Email address *
Child’s (First/Last) Name *
Your answer
Child's Date of Birth *
MM
/
DD
/
YYYY
Name of Child’s Parent #1 (Person completing this application) *
Your answer
Name of Parent #2
Your answer
Is the person completing the application the child’s legal custodian or, if the parents have shared parenting, the child’s primary residential parent? *
Please list the names & ages of any other children who reside primarily in your home.
Your answer
Please list an other individuals who live in your home, along with the relationship to child.
Your answer
Address *
Your answer
City *
Your answer
Home phone number
Your answer
Cell phone number
Your answer
Email address
Your answer
Has your child ever attended preschool? *
If Yes, please list preschool(s).
Your answer
If Yes, please list how long your child attended.
Your answer
List two preschools in order of preference. *
Your answer
First Parent's Employer
Your answer
Occupation
Your answer
Length of Time with Employer
Your answer
Second Parent's Employer
Your answer
Occupation
Your answer
Length of Time with Employer
Your answer
Family gross household income for 2019 (for your household). When selecting a range, please include child support, spousal support, disability benefits (either means-tested or work-based), unemployment compensation, and any income from any other source. *
If child’s parents reside in separate households, please also indicate below the other parent’s gross household income in 2019:
Will you be sharing the cost of preschool with any other person not identified on this application? (i.e. grandparent or other relative) *
Does your child qualify for any other reduced or free preschool programs like Helping Hands or Head Start due to a learning delay or physical disability?
Your answer
Is there any other information you would like the DEG Scholarship Committee to know about your family’s situation (i.e. extensive medical bills, unexpected hardship, etc.)?
Your answer
I have read, understand and agree to the guidelines listed below, and to the best of my knowledge and belief, the information provided on this application is accurate.
Type name for E-Signature
Your answer
Guidelines for awarding and distributing the DEG Preschool Scholarship
• The DEG scholarship is intended to ensure that the child has a structured preschool experience prior to entering Kindergarten. Research supports the importance of this learning experience for future success in Kindergarten as well as later grades.

• Priority for the DEG scholarship will be given to PTA member’s children and/or to children who have not previously had any preschool experience.

• Scholarship applicants must reside in Medina County.

• The Scholarship Committee maintains a strict non-discriminatory policy when considering and awarding the scholarship monies. Additionally, all information contained on this form remains strictly confidential.

• The amount of the Diane E. Guenther scholarship is $1,000.00.

• The Medina Early Childhood PTA (MECPTA) is matching the Guenther family's donation of $1,000.00; thus, two scholarship recipients will be selected to each receive $1,000.00 to be used for attending preschool.

• Scholarship(s) are awarded in May. Families will be notified by telephone if they are selected as the recipient. Payment of the scholarship money is made directly to the family’s selected preschool.

Applications submitted through this Google Form will not be accepted after April 15, 2020.
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy