Skate Wild Trips Scholarship Application Form
Please fill out for Full or Partial Scholarships/ Financial aid
Child's Full Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Child's Gender
Male
Female
What trip are you requesting assistance to attend?
Scholarship Amount Requested
$
Family Information
Parent Info
Parent Name
First Name
Last Name
Email
example@example.com
Home Phone
-
Area Code
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Other children in family
Configurable list
*
Additional Information
Monthly Family Income (Gross)
$
Additional Income
Income ($)
Welfare AFDC
Child Support
Support from Spouse
Social Security
Income from 2nd Job
Other
Total Additional Income
Total Monthly Income
Please upload most recent tax returns for proof of income.
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