OmniKen Edu Scholarship Application
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Student Name
*
Grade Level
*
Please Select
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
High School Graduate
Last Name
*
Address
*
Street Address Line 2
Street Address Line 2
City
City/ State / Zip Code
Postal / Zip Code
Phone Number
Email
example@example.com
Parent/ Guardian Name
*
Parent/ Guardian Phone Number
*
Parent/ Guardian Email
*
example@example.com
Were you referred by a current student
*
Yes
No
In order to qualify for the scholarship, you must upload either a copy of your free/reduced lunch form or proof that your family receives food stamps/government assistance.
*
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