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The Third Place for Kids Birthday Party Scholarship Application

A fully covered birthday party at The Third Place for Kids

Basic Information

What is your child's birthday?
Month
Day
Year

Party & Family Information

Have there been barriers that have made it difficult to host a birthday party for your child? (Check all that apply)

Family & Child Information

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

Does your child have a diagnosis related to neurodivergence, disability, or sensory processing? (Please check all that apply)
How did you hear about this program?
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
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