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Home
About
Who We Are
Staff
Board of Directors
Our Services
Emergency Assistance Services
Emergency Financial Assistance
Food Pantry
Senior Services
Youth Programs
United Learning Summer Camp
United Learning After-school Program
Community Room
Get Involved
Give
Volunteer
Event
Sign-up for E-News
News
Contact Us
Home
UCHM After-school Financial Assistance Program Application
UCHM After-school Financial Assistance Program Application
Please enable JavaScript in your browser to complete this form.
Parent/Guardian Name
Child/Children Name
How many days a week will your child attend the program?
1-2 Days
2-4 Days
5 Days
Parent/Guardian Place of Employment
Annual Household Income
Household Size
Please briefly explain why you are applying for financial assistance.
What amount are you able to pay per week?
$20
$15
$10
$5
$0
Phone
Submit
