UW-La Crosse Extended Learning
Summer Youth Program Scholarship Application - Need-Based
June–August, 2021| For youth entering grades 1–12
Scholarship criteria are based upon financial need and academic merit or teacher recommendation.
1. COLLECT SUPPORTING DOCUMENTS:
Provide one of the following:
• The first page of your 2020 Federal Income Tax Form – child’s name must be listed as an exemption
• A letter of explanation if a 2020 Federal Income Tax Form was not filed
• A letter from the child’s school indicating the child received free meals at school or was eligible for free meals at
school
Provide on
e of the following:
• Student’s current grade report in good academic standing
• Letter from school representative supporting student’s academic standing and respective situation
Age Grade Entering Fall 2021
State Zip
Email Addres
s
2. COMPLETE THE FORM BELOW:
Program Name
Child Name
Child Date of Birth
Address
City
Home Phone
Parent/Guardian #1 Name & Daytime Phone
Parent/Guardian #2 Name & Daytime Phone
School Name/Location
Number of children living in your household
I certify the above information to be true and correct.
Signature of Parent/Guardian
Date
3. SUBMIT this form and supporting documents to:
For assistance contact:
UW-La Crosse Extended Learning
ex@uwlax.edu | 608.785.6500
• Scholarship decision and registration instruction notification will be sent no later than June 8, 2021.
• Please refer to www.uwlax.edu/ex/youth-programs/scholarships for information regarding the percentage of program fees that will be provided through a scholarship.
• If awarded a scholarship, you are required to pay the difference (rounded to the nearest dollar) between the chosen summer program and the scholarship amount.
Your payment of this difference secures your registration for the program.
• Each student may only receive one UWL Extended Learning scholarship per summer. Scholarships are good for one Extended Learning youth program per summer only
and does not include supply/equipment fees. Scholarships are not available for programs $321 or more.
Submit your applications as early as possible:
First submission date: April 30, 2021 | Notification date: May 11, 2021
Second submission date: May 31, 2021 | Notification date: June 8, 2021
Funds are awarded on a first-come, first-served basis.
https://liquidfiles.uwlax.edu/filedrop/EX
