YMCA Youth in Government Middle School Scholarship Application
Information is confidential and will be used to determine eligibility for YMCA scholarships. Incomplete applications will not be considered. The YMCA may request additional information in order to determine scholarship eligibility and award amount.
Middle School Model Legislature Conference Scholarship Form
Student Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
example@example.com
School
Phone Number
Please enter a valid phone number.
Parent 1 Name
First Name
Last Name
Parent 1 email
Parent 1 Employer
Parent 1 Position/Job
Parent 1 Wages/Salary - Please describe hourly or weekly, with average hours per week if hourly.
Parent 2 Name
Parent 2 email
Parent 2 employer
Parent 2 position
Parent 2 Wages/Salary - please describe hourly or weekly, and average hours if hourly.
Rent/Mortgage Amount
Utilities
Car payments/insurance
Food
Medical
Other (please describe)
Please describe any circumstances, outstanding expenses, or other additional information that may help us better assess your application.
Submit
Should be Empty: