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2. Instructions

   1. The information below must be completed by a parent/guardian. Please ensure that you enlist all youth family members in your household. If the application is approved, anyone not listed will not have access to the scholarship funds. 

   2. The application must include necessary proof of Elk Grove residency and income, and all supporting documentation must be in the applicants name. Incomplete application packets will  be denied. 

   3. Submit applications to:

   1. Administration Office, 8820 Elk Grove Blvd., Monday-Thursday 8am-5pm, Friday 8am-12pm
   2. Wackford Community and Aquatic Complex, 9014 Bruceville Rd., Monday-Friday 8am-8pm, Saturday and Sunday 8am-5pm
   3. Albiani Recreation Center, 8830 Sharkey Ave., Monday-Friday 9am-5pm

   
   

   
   

6. PART 1: PARENT/GUARDIAN/ACCOUNT INFORMATION
8. Name:*
9. Birthday:*
10. Gender:
11. Day Phone:*
13. Address*
15. City*
16. State*
17. Zip Code*
19. Email:*
21. Youth Applicants-List Program Preference:
23. Name:*
24. Gender:
    -- Select One --MaleFemaleNon-Binary
25. Birthday*
27. Activity #1:*

    Please be as specific as possible. Provide the activity number and activity name. 

    Example: #12345 T-Ball League LCP Age 3-4 THU

28. Activity #2:
29. Activity #3:
31. Name:
32. Gender:
    -- Select One --MaleFemaleNon-Binary
33. Birthday
35. Activity #1:
36. Activity #2:
37. Activity #3:
39. Name:
40. Gender:
    -- Select One --MaleFemaleNon-Binary
41. Birthday:
43. Activity #1:
44. Activity #2:
45. Activity #3
47. Proof of Residency*

    1. Driver's License
    2. Utility Bill
    3. EGUSD Enrollment
49. Upload Proof of Residency*
51. Proof of Income:*

    1. 1040 Income Tax Return
    2. Food Stamps (CalFresh)
    3. CalWORKS
    4. Supplemental Security
    5. Disability Benefits
    6. Welfare Program
    7. Other
53. Upload Proof of Income*
55. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
57. Electronic Signature*
Leave This Blank:


59. 1. Receive an email copy of this form.
60. Email address

    This field is not part of the form submission.

61. Submit

* indicates a required field