Scholarship Application - Scholarship Application Portal

Participant Information

Participant Name *

Date of Birth *

Gender *

Street Address *

City

State

ZIP

Phone Number *

Email Address *

Parent / Guardian 1 (if participant is a minor)

Full Name

Date of Birth

Gender

Street Address

City

State

ZIP

Phone Number

Email Address

Parent / Guardian 2 (optional)

Full Name

Date of Birth

Gender

Street Address

City

State

ZIP

Phone Number

Email Address

Activity / Program

Activity / Program Name *

Start Date *

Start Time *

Location / Facility *

Fee ($) *

$

Activity 2

Start Date

Start Time

Location / Facility

Fee ($)

$

Supporting Documents

Please, upload Fre/Reduced School Lunch Program document. Accepted formats: PDF, JPG, PNG.

Document *