top of page

The Third Place for Kids Membership Scholarship Application

Providing access to a space where every child and their family can belong

Basic Information

Family & Child Information

The following two questions help us track community need and secure grants to fund future scholarships.

Do any of the children in your household have a diagnosis related to neurodivergence, disability, or sensory processing? (Please check all that apply)
Does your family currently have a "third place" (a space outside of home, school, or work) where you all feel truly comfortable and included?
Yes
No
How did you hear about this program?
If you were not selected for a scholarship, what factors might make it difficult for your family to get a membership to The Third Place for Kids? (Check all that apply)
What other activities or commitments are currently part of your family's routine? (Check all that apply)
Is your family currently enrolled in Medicaid or any disability-related waiver programs? (Check all that apply)

Permissions & Optional Information

Would you be willing to share a photo of your child(ren) that we may use to show donors the impact of this scholarship?
Yes, I will upload a photo
No, I prefer not to share a photo

These photos will only be shared in private donor meetings and funding discussions. They will not be used on social media or public materials. Names will never be used.

Do you consent to The Third Place for Kids sharing your story (without using names) to help secure funding and provide more scholarships to families like yours?
Yes
No
Some of our scholarships are made possible by individual donors who want to support families like yours. If selected through donor sponsorship, would you be interested in writing a thank-you note to share your appreciation?
Yes, I would like to write a note
No

This is completely optional and will not affect your application.

Agreement & Next Steps

By signing below, I confirm that:


The information provided in this application is accurate to the best of my knowledge.


I have read and agree to the Terms & Conditions of The Third Place for Kids Scholarship Program.


If selected, I will follow the guidelines and expectations outlined in the program.


I understand that providing false or misleading information may result in disqualification.

Date
Month
Day
Year
bottom of page