Scholarship Application Request Form
Education Department

Full Name*
Street Address*
City, State, Zip*
Phone*
Email*
I am interested in program/kids camp*
Amount* I am requesting a scholarship of:
25% of program cost, I can pay 75%
50% of program cost, I can pay 50%
75% of program cost, I can pay 25%
100% of program cost, I cannot pay anything at this time
Any notes you wish to share:
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