SCHOLARSHIP APPLICATION for SCL 2021

SCHOLARSHIP APPLICATION

for STUDENT CONSERVATION LEADERS 2021
Both this application and the Student Conservation Leaders application must be received by 11:59 p.m. EST April 15th, 2021.

Applicants will be notified of their scholarship status by April 30th, 2021.
Student's Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Parent or Guardian's Name *

First Name Last Name
Parent/Guardian's Phone Number *

Area Code Phone Number
Parent/Guardian's Email
example@example.com
Scholarship Request: *

25% Scholarship (Program Fee = $75) 50% Scholarship (Program Fee = $50) 75% Scholarship (Program Fee = $25) 100% Scholarship (Program Fee = $0)
For the household in which the student resides, what is the adjusted gross income? Refer to your 2020 federal tax form 1040 (line 37), 1090 (line 4) or the Ohio tax form 1040 (line 1) *
Number of adults in household: *
Number of children in household: *
Parent/Guardian: Please briefly describe your financial situation, why you are requesting a scholarship, and why your child should be granted this scholarship: *

0/400
You may be asked to submit a recent pay stub or tax return as verification of financial need.

Please direct any questions or concerns to Evan Banzhaf, program manager, at 513-279-2006 or ebanzhaf@ohioriverfdn.org.
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