Application for Membership Dues Waiver

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This application is designed for prospective and/or current RCHAL members requesting financial assistance in the form of an annual Membership Dues Waiver. This form must be completed/resubmitted by the applicant annually and reviewed by the Board.

Information provided does not necessarily qualify or disqualify you. Please answer to the best of your ability.

Please note....all information disclosed will remain confidential, only being viewed by the members of the RCHAL Board.

1. *	Date of request:

2. *	First and Last Name of parent applying for assistance:

3. *	E-mail address:

4. *	How long have you been a member of RCHAL?

5. *	Please list volunteer commitments within RCHAL over the last 2 years:

6. *	Why are you requesting an annual membership dues waiver?

7. *	Have you received any scholarships or waivers from RCHAL in the past? If yes, please provide details and include school years.

8. *	Is any member of your family currently serving on the RCHAL Board?

Terms: A response to your request will be sent via email within a week of the application's submission. If a fee waiver is approved, direction will be provided as to how to proceed with membership registration or renewal.