Scholarship Application — The Sensory Village Foundation

The Sensory Village Foundation Scholarship supports individuals and families who may benefit from inclusive sensory-based programs, services, and experiences. Our goal is to increase access to safe, supportive, and enriching opportunities for participants of all abilities.

Participant Information

Participant's Full Name *

Date of Birth

Parent / Guardian Name *

Phone Number *

Email Address *

Address

City / State / ZIP

Household Information (Optional but helpful)

Number of people in the household

Household annual income range (optional)

Under $25,000 $25,000 – $50,000 $50,000 – $75,000 $75,000+ Prefer not to say

Participant's Needs & Background

Does your participant have a diagnosed condition or developmental difference?

Yes No Prefer not to say

If yes (optional explanation)

What supports or services does your participant currently receive?

Scholarship Request

What are you applying the scholarship toward?

Sensory play programs Classes or enrichment programs Membership / entry support Special Events

Other

Funding purpose limits. Scholarships may only be used for admission fees, program participation, and memberships or approved Sensory Village experiences. Funds may not be used for cash payouts, non-related personal expenses, or third-party services not affiliated with The Sensory Village.

Impact Statement

Briefly explain why you are applying for this scholarship.

How would receiving this scholarship benefit your participant or family?

Additional Information

Is there anything else you would like us to know?

Agreement

I certify that the information provided is true and accurate to the best of my knowledge. I understand that scholarship awards are based on available funding and eligibility. *

Parent / Guardian Signature (type your full name) *

Date *