Scholarship Application

"*" indicates required fields

Must be completed by Parent/Caregiver AFTER their student’s application is complete.

Name of Parent/Caregiver*

First Last

Home Address*

Street Address Address Line 2 City State ZIP Code

Parent/Caregiver Phone*

Parent/Caregiver Email Address*

Parent/Caregiver Occupation*

Student's Name*

First Last

Relationship to Student*

Number of people in household(s)*

Number of dependents in household(s)*

Please include age and relationship to student for each dependent listed

Approximate Household Annual Income*

Student lives with:*

Father

Mother

Both

Other

Is your family:*

One-income family

Two-income family

Other

Explain reason why student will need a scholarship*

Amount requested from the Scholarship Fund is:*

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