DSA of Delaware Scholarship Application | Down Syndrome Association of Delaware

Scholarship Application

Examples for use of Scholarship Program: camps, recreational sports, fine arts (music, dance, art), educational extracurricular activities

Requestor's Name(Required)

First Last

Individual with Down syndrome's Name(Required)

First Last

Individual with Down syndrome's Date of Birth(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Email(Required)

Does participant have Down syndrome?(Required)

Are your Membership Dues current?(Required)

Within the last year, has a member of your family volunteered with the DSA of Delaware? Please provide date and description of event.(Required)

Scholarship Request

Program Type(Required)

Program Name(Required)

Date(s) Attending(Required)

Program Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Program Type(Required)

Program Director's Name and Phone Number(Required)

Program Director's Email Address(Required)

Description of Program(Required)

How does this program benefit the individual with Down syndrome?(Required)

Cost of Program?(Required)

Amount Requested?(Required)

(Maximum amount requested not to exceed $300 per fiscal year)

Criteria for Approval

Membership dues must be current and contact information is valid. Requester must have volunteered with the DSA of Delaware within the past year. The "criteria for approval" is waived for new families with less than 2 years as a DSADE member or has contributed minimum of $1,000 through fundraising for the DSA of Delaware. *Please note funds will be paid to program provider directly if awarded. We do not provide payment reimbursements.

By typing your name below, you are electronically signing this form.(Required)

I understand.

Requestor's Name(Required)

Today's Date(Required)

Approval for any request is at the discretion of the Scholarship Committee and/or Board of Directors. Only 1 Scholarship or Financial Assistance per membership per fiscal year (June 30-July 1), unless otherwise agreed upon by the DSA of Delaware Board of Directors.

Questions? Email Lauren at executivedirector@dsadelaware.org.