The Kroc Center
Scholarship Program
Membership 2015
SCHOLARSHIP ELIGIBILITY REQUIREMENTS & GUIDELINES:
The following documents are required for all individuals residing in the *Household (including roommates and ALL non-family members):
Address verification (must be a recent lease or utility bill such as SDGE in one of the zip codes listed below). Cell phone bills are not acceptable.
SAN DIEGO COUNTY
Verification for all individuals in the household:
o Photo ID required for all adults in the home
o Identification for all children in the home (NO SOCIAL SECURITY CARDS)
Current proof of income for ALL individuals living in the household
Applicant Last Name: _ __ First Name: __
Email Address:______Phone Number:______
MEMBERSHIP REQUEST (All memberships are valid for 1 year):
Family Membership - 2 adults living in same household and up to 6 children
Gold - $85-257 Silver - $67-202 (Silver DOES NOT include child care &fitness classes)
Single Parent Family Membership - Single parent and up to 6 children
Gold - $66-198 Silver - $59-158 (Silver DOES NOT include child care & fitness classes)
Adult Membership – Ages 18 - 61 years old
Gold - $42-126 Silver - $31-94 (Silver DOES NOT include child care & fitness classes)
Senior Membership – Ages 62 and over
Gold - $36-108 Silver - $22 -151 (Silver DOES NOT include child care & fitness classes)
Teen & Youth Memberships –
Teen - $16-48 Youth - $14 - 43
List ALL persons membership will include:
Applicant Name / Relationship to Applicant And AgeExample: María Espinosa / Daughter ( 8 years old)
Self/Applicant
By signing below I certify that I have read and understand the scholarship program guidelines. Recipients must use the Membership funded. Future requests for scholarship assistance by the same applicant may not be considered if funds or programs are misused and/or not used appropriately.
Signature: Date: ______
*A HOUSEHOLD is defined as ALL individuals residing within the home, including non-family members.
Family Resource Center ● 619.269.1430 ● Fax 619.255.3238 ●