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Instructions
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Scholarship Agreement Form
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Scholarship Request Form
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Household and Financial Verifications
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Final Steps
The Salvation Army Kroc Center
Scholarship Program
The Salvation Army Kroc Center is pleased to provide a comprehensive scholarship program to help provide access to this facility. It was Joan Kroc’s vision and expectation that all individuals have equal opportunities to grow their natural gifts and talents. Friends and supporters of The Salvation Army Ray and Joan Kroc Corps Community Center have created a Scholarship Fund which helps low-income families to afford Kroc Center activities and programs by providing a discount. Our aim is to aid people in having positive life-changing experiences through arts, athletics, personal development, spiritual discovery, and community service.
Instructions
Please complete the following application. Copies of proof of income for all who are living in the residence. (See below for documents needed.) Completion of application does not guarantee assistance. Scholarships will be awarded based on eligibility, funding, timeliness, and space available.
Scholarship Information
Assistance is given to those with a proven financial need. The sliding scale is based on household size and income. Any information found to be fraudulent will result in loss or denial of current and future scholarship awards.
The following documents are required for all members living in the residence (including roommates, and non-family members):
Proof of Household Size
• Photo ID required for all adults.
• Birth certificate, insurance card, or school IDs will serve as proof for children (Only 1 document required per child)
• Lease agreement or a copy of the deed will serve as housing verification. If you live in a shelter, please submit a letter from a case worker verifying your residency.
Proof of Income
• Current proof of income for all who live in the household:
Current pay stubs to prove 1 month's income, TANF Notice of Action (OWF Statement), Child Support/Alimony, Social Security, Food Stamp statements, Unemployment documents, first two pages of your Federal Tax Return
- If no income is claimed by an adult, a signed and notarized "Zero Income Verification Form" is required.
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01
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Instructions
02
.
Scholarship Agreement Form
03
.
Scholarship Request Form
04
.
Household and Financial Verifications
05
.
Final Steps
The Salvation Army Kroc Center
Scholarship Program
Scholarship Agreement Form
It can take up to seven business days to process the request. Incomplete applications will not be processed. Applicants will be notified regarding their application status via email.
Program Information
• Scholarship recipients will be asked to contribute towards the Class/Program fees. Scholarship application deadlines are based on each individual program. Please speak to the Program Coordinator for specific dates for your desired program.
• Once approved, recipients will be expected to pay their agreed portion of the fee. Class/program spots will not be held until the recipient’s portion has been paid. Recipients who also choose to use a payment plan (for select programs only) will be required to make the first payment only.
• Recipients must use the Membership/Class that has been funded. Future request for scholarship assistance by the same applicant may not be considered if funds or programs are misused.
• All Scholarship awards are confidential. Applicants agree to refrain from discussing awards with others.
For Membership Scholarship Applicants:
You may make your membership payment in one of the following ways: You may pay your portion of the annual membership or you may set up a monthly cash installment. When you come in to complete your membership registration, please be prepared to pay your portion of either the annual amount or monthly payment amount. Should you lapse on your payment schedule we reserve the right to terminate the scholarship award.
Expectations for All Scholarship Recipients:
• Scholarship recipients are expected to financially contribute toward the membership/program:
Recipients will be asked to provide a portion of the Membership/Program fee based on financials and other eligibility. We do not do 100% scholarships. Our scholarships range from 20% - 50% off of the program/membership price
.
• Scholarship funds will only be made available to select memberships/programs:
Programs include, but are not limited to sports leagues, camps, classes, etc.
•
Non-Use of your Kroc Center membership/program may result in discontinued Scholarship assistance:
Programs/Classes and Camps which have received scholarship support must be attended by recipient. Future requests by the same applicant may not be considered if funds or programs are misused.
•Scholarships are valid for 12 months from approval:
Re-applying will be required at the end of the scholarship period and continued use will be dependent upon information and frequency of previous use at the Kroc Center.
Please sign below as verification of your understanding and acceptance of the Kroc Center Scholarship Agreement.
Signature of Scholarship Applicant/Parent or Guardian of Recipient
Clear
Name
Date
MM
/
DD
/
YYYY
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01
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Instructions
02
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Scholarship Agreement Form
03
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Scholarship Request Form
04
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Household and Financial Verifications
05
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Final Steps
The Salvation Army Kroc Center
Scholarship Program
Personal Contact Information
Name of Primary Adult
Address
Primary Adult's Cell Phone
Primary Adult's Secondary Phone
Primary Adult's Email
Date of Birth
MM
/
DD
/
YYYY
Gender
Male
Female
Other
What is the total number of individuals living in the household?
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Other Household Members
Please list all members (adults, children, family and non-family) in your household.
First / Last name
Date of Birth
MM
/
DD
/
YYYY
Gender
Male
Female
Other
Add more
Are you currently a member of the Dayton Kroc Center?
Yes
No
What type of scholarship are you requesting?
Program Scholarship
Membership Scholarship
Membership Scholarship
Please select the type of membership for which you would like to be considered.
Individual Basic Membership
Family Basic Membership
Fitness Class Membership
PrimeTime Membership (55 and older)
How many people (including yourself) would you like on your Family membership?
4 members
5 members
6 members
7 members
Program Scholarship
Is the scholarship for the primary adult?
Yes
No
Select the program/activity category
Music
Men's/Women's Ministries
Summer Day Camp/Summer Experiences
Sports League
Recreation Program
Name of Program
Are you applying for scholarships for multiple individuals in your household?
Yes
No
How many individuals from your household are in need of a scholarship?
- Select Number -
2
3
4
- Select Number -
Participant #1
Name of Participant #1
Date of Birth
MM
/
DD
/
YYYY
Does this child attend DPS?
Yes
No
If so, what school does your child attend?
Select the program/activity category
Fitness Programming
Recreation Programming
Education Programming
Other:
Name of Program
Please name the specific program the participant would like a scholarship for.
Participant #2
Name of Participant #2
Date of Birth
MM
/
DD
/
YYYY
Select the program/activity category
Fitness Programming
Recreation Programming
Education Programming
Other:
Name of Program
Participant #3
Name of Participant #3
Date of Birth
MM
/
DD
/
YYYY
Select the program/activity category
Fitness Programming
Recreation Programming
Education Programming
Other:
Name of Program
Participant #4
Name of Participant #4
Date of Birth
MM
/
DD
/
YYYY
Select the program/activity category
Fitness Programming
Recreation Programming
Education Programming
Other:
Name of Program
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01
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Instructions
02
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Scholarship Agreement Form
03
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Scholarship Request Form
04
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Household and Financial Verifications
05
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Final Steps
The Salvation Army Kroc Center
Scholarship Program
Household Verifications
Please upload your proof of household size:
• Photo ID required for
all adults
.
• Birth certificate, insurance card, or school IDs will serve as proof for children (Only 1 document required per child)
• Lease agreement or a copy of the deed will serve as housing verification. If you live in a shelter, please submit a letter from a case worker verifying your residency.
Delete all uploads
Choose files or drag here
Annual Household Income
Please check ALL income received from all adults in your household from the list below.
Wages
Unemployment
Child Support
SS Income
Food Stamps
SS Disability
Section 8/HUD Housing
No Income Received
Other:
Financial Verifications
Please upload proof of
ALL INCOME
selected and received in the household.
Delete all uploads
Choose files or drag here
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01
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Instructions
02
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Scholarship Agreement Form
03
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Scholarship Request Form
04
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Household and Financial Verifications
05
.
Final Steps
The Salvation Army Kroc Center
Scholarship Program
Reason for Request: (Please list any special circumstances you would like us to know)
This application and required income documentation are confidential information and will be used only for the purposes of this scholarship application.
Please click the circle to confirm your acknowledgements
I acknowledge that I must provide originals for the required documents to be considered for a scholarship. I also confirm that the information that I have provided both in this form and the documentation I will provide are accurate and correct.
Name of Primary Adult
Signature of Primary Adult
Clear
Date
04
/
02
/
2025
SUBMIT FORM
Please wait...
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