SCAC Summer Camp 2008 Scholarship Application Print and mail this form along with your registration form to: Second Chance Animal Center P.O. Box 620 Shaftsbury, VT. 05262 Attn: Dana Coleman Applicant's Name:__________________________________________ Parent/Guardian's Name:____________________________________ Address__________________________________________________ _________________________________________________________ Phone:________________________ Date:______________________   Do you participate in any of the following public assistance programs? 1. Social Welfare-Aid to Needy Families with Children YES NO 2. Food Stamps YES NO 3. Women, Infants & Children Program (WIC) YES NO 4. Vermont for Kids - child support YES NO 5. Reach Up - Education & Job Training YES NO 6. General Assistance/Relief YES NO 7. AABD/EP Financial Support for spouse/caregivers YES NO 8. Medicaid YES NO 9. Medicare YES NO 10. Prenatal & Children w/Health Assistance - Dr. Dynasaur Program YES NO 11. Fuel Assistance/Heating Costs YES NO 12. Section 8 Rental Assistance YES NO 13. SSI - Supplemental Security Income YES NO 14. Lifeline/Telephone Costs YES NO 15. Social Security (as main source of income) YES NO         If you do not participate in any of the above programs, you may still qualify for this program. Please give us information on the back of this application that would help clarify your need for financial assistance. back to top Second Chance Animal Center P.O. Box 620, Shaftsbury VT 05262 Ph: (802) 375-2898 Fax: (802) 375-0235 Email: secondch@sover.net Adoption | Community Services | Volunteer | Questions | Support Us Events | Visiting | Lost & Found | Links | Home