PROJECT SMASH: Scholarship Application Form

PROJECTSMASH.ORG

SCHOLARSHIP APPLICATION
Student Legal Name*

First NameMiddle NameLast Name
Student Preferred Name*
Nickname
Parent/Legal Guardian(N/A if you are the student)

PrefixFirst NameLast NameSuffix
Student's Date of Birth*

MonthDayYear
Date
Relationship
Relationship to Student
Are you applying for yourself or your child?*
Email*
example@example.com
Phone Number*

Area CodePhone Number
Student Address*

Street Address

Apt/Unit/Suite Number

CityState

Zip Code

HOUSEHOLD INFORMATION
HOUSEHOLD SIZE*
Number of Persons in Household
Annual Household Income*
Gross Income (before Deductions) per Year
Does Your Family Receive Any Type of Assistance? (Check all that apply)*

TANFSNAPSSIMedicaidNSLPTemporary CrisisNone of these applyOther
Upload copy of : PROOF OF GOV. ASSISTANCE- WIC, SNAP, MEDICAID-DOCUMENTS ONLY! (NO PERSONAL PHOTOS)

Browse Files

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FINANCIAL INFORMATION
Is Scholarship Needed Due to a Temporary Financial Hardship?*

YesNo
In A Few Sentences, Please Describe Your Current Financial Circumstances*
How long would you need the scholarship for?/ How much aid would help? (Partial scholarships available too)*
This will help us better determine how much you will recieve.

PERSONAL STATEMENT OF AGREEMENT
SCHOLARSHIP ELIGIBILITY REQUIREMENTS

(Qualifications may vary between San Antonio and Las Vegas)
- If your scholarship surpasses 3 months or you are renewing for the 2nd time, you are required to help Project SMASH with a small fundraiser.
- If this is your 3rd time renewing you will be asked if you can volunteer.
- We ask that you purchase a Project Smash tee at the front desk. Must be worn at every class.
- Attendance is mandatory. Your scholarship may be revoked and/or will be placed under review if you miss 3 or more classes in a row.
- A photo for our sponsers. Photos may be taken for Project SMASH promotions, grants, donor relations.
Do You Agree to Participate in PROJECTSMASH.org Fundraisers (if asked)*

YesNo
Do You Agree to Volunteer/Assist with PROJECTSMASH.org Events (if requested)*

YesNo

INDENTIFYING DEMOGRAPHICS

(Optional: Providing the Identifying Information; as requested in this section, assists us understand and collect demographic Information used to continue to provide scholarships to our community in need.)
Student Date of Birth

MonthDayYear
Date
Student Gender

MaleFemaleNon-BinaryOther
Student Ethnicity (this helps us when we apply for grants)

Hispanic or LatinoNon-Hispanic/LatinoAfrican AmericanAsianOther

I CERTIFY THAT ALL STATEMENTS OR INFORMATION I HAVE PROVIDED ABOVE ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE. ANY DELIBERATE MISREPRESENTATION FOUND IN THIS APPLICATION MAY BE CAUSE FOR THE APPROVAL OF THIS APPLICATION AND MAY PROHIBIT ME FROM APPLYING AGAIN IN THE FUTURE.
Applicant's Signature*

Clear
Name of Applicant*

First NameLast Name
Date Signed by Applicant

MonthDayYear
Date
Should be Empty:

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