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2. PROGRAM GUIDELINES
   • Each scholarship applicant must be a resident of Powhatan County.
   • Scholarship applications must be filled in with signatures of parents/guardian for all children under the age of 18.
   • Individuals registering for multiple activities must fill out a separate scholarship application and registration form for each activity.
   • Recipients must pay at least 50% of the program cost. 
   • Approved scholarships must accompany an activity registration form.
   • Applications may take up to 5 business days to process. 
   • All scholarships are subject to availability and funds will be awarded per activity, primarily on a first come, first serve basis for eligible applicants. 
   • Some programs may have a scholarship limit.
   • Scholarships are not available online through the online registration process. 
4. Scholarship Type:*

   1. Class Scholarship
   2. Camp Scholarship
   3. Activity Scholarship
6. Applicant Name:*
7. Date of Birth:*
   Date of Birth:
9. Applicant Phone Number:*
10. Applicant Email:*
12. Applicant Street Address:*
14. City
15. State
16. Zip
18. Participant Type:*

    1. Dependent
    2. Senior Adult (65+)
    3. Adults with Disabilities
20. Please list full name(s) of all household scholarship participants, if different than applicant.
22. Name
23. Date of Birth
    Date of Birth
25. Name
26. Date of Birth
    Date of Birth
28. Name
29. Date of Birth
    Date of Birth
31. Name
32. Date of Birth
    Date of Birth
34. Name
35. Date of Birth
    Date of Birth
37. Verification of Financial Need:*

    1. VA Cardinal Card
    2. Medicaid Card
    3. SNAP Card
    4. TANF
    5. Financial Hardship Letter
38. Card Number:*
39. Verification Letter*

    If you do not meet the verification criteria for financial aid you may write a financial hardship letter to support your request. This will be reviewed and considered by recreation program staff. 

41. Acknowledgement

    By submitting this form, I acknowledge that this document is a public record under both the Virginia Public Records Act and the Virginia Freedom of Information Act.  As a public record, it must be retained by Powhatan County in accordance with relevant retention time periods and may be subject to release under the Virginia Freedom of Information Act.

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43. 1. Receive an email copy of this form.
44. Email address

    This field is not part of the form submission.

45. Submit

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