This is a questionnaire for a scholarship for CISV Jacksonville chapter for minicamp programs.
Name of Youth Applicant
*
First Name
Last Name
Name of Parent or Guardian
First Name
Last Name
Cell Phone of Parent
Please enter a valid phone number.
Email of Parent
example@example.com
Address of Youth Applicant
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Name of Youth's School
Does the youth applicant receive financial aid for school tuition?
Yes
No
Does the youth applicant receive free/reduced lunch?
Yes
No
Total number of family members residing with youth
FAMILY'S GROSS ANNUAL INCOME (from IRS Form 1040, Line 33, Adjusted Gross Income) - Most recent tax year
*
Please provide any additional details to be considered by Scholarship Committee.
STATEMENT OF PARENT(S) OR GUARDIAN(S)I (We) agree to accept the decision of the Minicamp Scholarship Committee. I (We) understand that all application information will be kept confidential by the Scholarship Committee, and that we are not to disclose any information to others regarding scholarship awards. I (We) also commit to support the Jacksonville Chapter with my (our) volunteer support during the next year. I (We) verify that all information provided in this application is, to the best of my (our) knowledge, accurate and complete. To indicate the delegate's parents' agreement to the foregoing, please click the box below and have all Parents or Guardians sign below.
*
Yes
Signature of Parent/Guardian #1
Clear
Signature of Parent/Guardian #2
Clear
Submit
Should be Empty: