Hope Scholarship Application Form

Hope Scholarship Application Form

The following form is encrypted and CAPTCHA enabled for the protection of your information.
Student Information
Student Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Student 2 Name

First NameLast Name
(Student 2) Date of Birth

MonthDayYear
Date
Student 3 Name

First NameLast Name
Student 3 Date of Birth

MonthDayYear
Date
Family Address *

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parental Information
Name of Mother or Guardian*

First NameLast Name
(Mother/Guardian) Place of Employment *
(Mother/Guardian) Job/Position*
(Mother/Guardian) Email*
example@example.com
(Mother/Guardian) Cell Phone*

Area CodePhone Number
(Mother/Guardian) Work Phone

Area CodePhone Number
Address of Mother/Guardian (If different than family address)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name of Father or Guardian 2

First NameLast Name
(Father/Guardian 2) Place of Employment
(Father/Guardian 2) Job/Position
(Father/Guardian 2) Email
example@example.com
(Father/Guardian 2) Cell Phone

Area CodePhone Number
(Father/Guardian 2) Work Phone

Area CodePhone Number
Address of Father/Guardian 2 (if different than family address)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Ethnicity of Applicants (Optional)

African AmericanAsian AmericanMexican AmericanHispanic/LatinxWhiteAmerican IndianMulti-RacialOther

KWC Programs
What program is your student interested in applying for?

Touring CompanyFall ClassesSpring ClassesSpring Break CampMini CampJunior PACJune PACJuly International CampAll The Above

If you feel you need to provide additional information about your circumstances, please do so here.
Signature
I give my consent to have my child's name posted as a Hope Scholarship Recipient as needed by Kids Who Care.*

YesNo
I AFFIRM THAT ALL STATEMENTS I HAVE INDICATED HEREIN ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE. ANY MISREPRESENTATION I HAVE MADE CAN RESULT IN THE WITHDRAWAL OF FINANCIAL ASSISTANCE.
Applicant's Signature*

Clear
Date Signed by Applicant*

MonthDayYear
Date
Kids Who Care and the Hope Scholarship Committee reserve the right to withdraw a scholarship for the following reasons:

1. No payment of required fees.

2. Excessive Absences from programming as determined by programming staff.

3. Unacceptable behavior as determined by the staff.

4. Unreliable support from family (such as not providing transportation).

5. Other, as determined by staff and committee.
Should be Empty:

Student Information