Program Subsidy Application Form Step 1 of 5 20% *Please ensure you have submitted a Program Application Form for your child prior to submitting a subsidy request.Joseph McNamara Fund Financial aid has been made possible by the generous donations made to LDANR in memory of Joseph McNamara. To celebrate Joseph, and show our appreciation for this kind gesture, LDANR has established a yearly fund in Joseph McNamara's name, beginning with the generous donations that have been received in memory of him. Future donations will help in sustaining this fund to provide subsidy for families who require financial aid. Thank you, Joseph McNamara and family, for your continued support of our agency. The Learning Disabilities Association of Niagara Region (LDANR) recognizes that some families in the Niagara Region cannot always afford LDANR programs. If you are a family who is seeking financial support when signing your child up for a LDANR program, please fill this form out to apply for financial assistance with membership/program fees. Please note that these forms are only filled out on a voluntary basis and are kept confidential. Once the form is completed and submitted, LDANR will review all submissions and if/when funding allows LDANR will provide the program at a discounted rate to the families demonstrating the most financial need. Please note that the completion and submission of this form does not guarantee LDANR financial assistance, as LDANR may not have sufficient funds to support all applicants.LDANR staff will notify you if financial assistance is available or fees can be waived. Directions: Please read the following statements and respond accordingly to the directions for each item. Amount Requested*After-School Program Fees LDA Member Fee $60 per child | Non-LDA Member Fee $95 per child *Annual LDA Family Membership Fee $50/yearFull Name of Child(ren)* Full Name of Caregiver*Caregiver Email* Caregiver Phone Number*Program*What LDANR program(s) did you apply to?Reading RocksReading Rocks JuniorLet's R.E.A.D.B.E.S.T. Social Skills ProgramS.L.A.M. Summer CampS.M.A.R.T. Math 1. Children*How many children do you have/support?12345 or more2. Marital Status*What is your marital status?Married/Common LawWidowedDivorcedSeparatedNever Married3. Education*What is the highest degree or level of school you have completed? If currently enrolled, mark the previous grade or highest degree received.No schooling completedNursery school to 8th grade9th, 10th or 11th grade12th grade, no diplomaHigh school graduate - high school diploma or the equivalentSome college credit, but less than 1 year1 or more years of college, no degreeCollege diplomaBachelor's degree (for example: BA, AB, BS)Master's degree (for example: MA, MS, MEng, MEd, MSW, MBA)Professional degree (for example: MD, DDS, DVM, LLB, JD)Doctorate degree (for example: PhD, EdD) 4. Employment Status*Are you currently...?Employed for wagesEmployed and receiving Ontario Disability Support Program (ODSP)Self-employedOut of work and looking for workOut of work but not currently looking for workA homemakerA studentRetiredUnable to workEmployer Type*Please describe your work.Employee of a for-profit company or business or of an individual, for salary, or commissionsEmployee of a not-for-profit or charitable organizationLocal government employee (city, county, etc.)Provincial government employeeSelf-employed in own not-incorporated business, professional practice, or farmSelf-employed in own incorporated business, professional practice, or farmWorking without pay in family business or farm 5. Housing*Is your house, apartment, or mobile home...?Owned by you or someone in this household with a mortgage or loanOwned by you or someone in this household free and clear (without a mortgage or loan)RentedLiving with someone without payment of rent6. Household Income*What is your total household income?Less than $10,000$10,000 - $19,999$20,000 - $29,999$30,000 - $39,999$40,000 - $49,999$50,000 - $59,999$60,000 - $69,999$70,000 - $79,999$80,000 - $89,999$90,000 - $99,999$100,000 - $149,999$150,000 or more 7. Volunteer Contribution*If provided with financial support, please indicate below in which way you will agree to contribute to the organization in another way. At least one option must be selected. Niagara Falls Bingo Volunteer (1-2 Wednesdays/year, 3:30 - 5:00 pm) St. Catharines Bingo Volunteer (1-2 Sundays/year, 7:30 - 9:30pm) Fundraising event volunteer (Golf Tournament, Trivia Night, Boston Pizza) 8. Required Explanation*In the space provided below, please indicate why you should be considered in the review of your subsidy application.