Scholarship Application
We believe that everyone should be able to participate in our programs regardless of their financial abilities. Participants who demonstrate financial need may be eligible for a scholarship to cover a portion of the cost of the program. Applying for a scholarship or receiving a scholarship in the past does not guarantee that additional scholarships will be awarded. We strongly encourage participants to pay as much as they are able so that scholarships will be available to others throughout the year. If the participant does not call or arrive to the scheduled lesson for two (2) lessons, the remainder of the session lessons will be forfeited and future scholarship eligibility may be re-evaluated. Note that all of the information provided in this Scholarship Application will remain confidential. It is the policy of Eagle Mount to maintain a non-discriminatory scholarship application process. Eagle Mount does not make scholarship decisions based upon age, sex, race, color, religion, national origin, disability, sexual orientation, marital status or veteran status.
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General Information
Participant Name: *
Address: *
Primary Phone Number: *
All Scholarship Applications must be submitted and co-pay must be received PRIOR to the start of a program.
Is the participant or a family member responsible for payment to Eagle Mount? *
If the answer to the above question is No, please complete the following questions.
Responsible party for payment:
Relationship to the participant:
Primary Phone Number:
Will you be working with another agency to provide payment? *
If your answer to the above question was Yes, please indicate which agency:
Please provide the name of the case manager at the agency providing payment:
Please provide the phone number of the case manager at the agency providing payment:
What programs will the participant, family or group engage in? *
What is the total cost of the programs the participant, family or group will engage in? *
How much will you contribute to help cover the cost of the program(s) you are interested in at this time?
Household Information
Employer and length of employment: *
Number of adults in the household: *
Number of children in the household: *
Number of household members with a disability: *
If in school, does the participant qualify for reduced or free lunch from the school district? *
How will the requested scholarship help the participant, family or group? *
Describe any other financial burdens or additional factors that should be considered: *
Volunteer Engagement
Answers to the questions below will not impact your consideration for a scholarship award.
Has the participant, family or group done any volunteer work for Eagle Mount in the last 12-15 months? *
If you answered Yes to the above question, please explain:
In what areas would you be interested in volunteering? *
Are there any other ways you would be willing to give back to Eagle Mount? *
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