La Peña Cultural Center’s

La Peña Cultural Center’s

Scholarship / Barter Application

Youth Names

1^st:____________________________________ Age: ________________

2^nd:___________________________________ Age: ________________

3^rd: __________________________________ Age: ________________

Parent: _____________________________________ Phone: ____________________________

Address: ______________________________________________________________________

Street City Zip

Programs

Please list the programs you are interested in taking:

______________________________________________________________________________

Fees

Please list the regular fees for these programs: ________________________________________

______________________________________________________________________________

What are you able to pay: ______________________ / MONTHLY or SEMESTER (circle one)

Can you barter for the remainder of fees? Yes / No

Please be realistic about your time commitments for work exchange.

Skills Needed: cleaning, data entry, recycling pick-up, reception during programs, office support, carpentry, help at events, other ideas welcome:

______________________________________________________________________________

What was your family income (as reported to the IRS) last year? _________________________

Please tell us about your circumstances to help us understand your need for a scholarship:

______________________________________________________________________________

____________________________________________________________________________________________________________________________________________________________

Please email it to <Sophia(at)lapena.org> or fax it to 510-849-9397, or mail it to La Peña, Attn. Sophia. 3105 Shattuck Ave. Berkeley, Ca. 94705