Scholarship Application
Fill out this form to apply for financial for ongoing membership.
First Name
Your answer
Last Name
Your answer
Phone Number
Your answer
Referred By:
Your answer
Please tell us what the financial circumstances are that prompted you to request a scholarship.
Your answer
Future change foreseen?
Do you anticipate that your financial situation will change in the future?
If so, when/how?
When do you expect this change to happen and how do you expect it to affect your situation?
Your answer
Proposed monthly dues
Average monthly dues are approximately $120/month. How much can you pay per month?
Your answer
Proposed yearly dues
Average yearly dues are approximately $60 for Adults, $50 for Teens & Tweens, and $35 for Kids per year. How much can you pay?
Your answer
Proposed registration fee
Proposed registration fee is $50. How much can you pay?
Your answer
Proposed testing fees
Average proposed testing fees are approximately $40 per one testing. How much can you pay?
Your answer
Proposed starting date
Length of commitment: (months)
Your answer
Your answer
Please email supporting financial documentation to
A photo of your tax return main page is best. Otherwise, a recent pay stub may also suffice.
Thank you for your interest in our dojo. Your request will be reviewed at the next meeting of our Board of Directors and you will be notified of their decision.
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