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Office use only Boys Girls Club of Corvallis Rec d Call date Proof of Income Attached Yes Scholarship Amt. This balance must be paid before your child can be registered in the requested program. Child s Name Date Address City Zip School Grade circle K 1 2 3 4 5 6 7 8 9 10 11 12 Parent or Legal Guardian Day phone Employer E-mail Program Requesting Scholarship For Program Cost Financial Information All blanks must be filled in with amount or N/A Family Size Number of Children Total Gross...
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