Student City Scholarship Request Form

Student City Scholarship Request Form

These monies are not simply to reduce the price of the camp but are intended for families in our community who would otherwise be unable to send their child to this event. Student City leadership team will follow up with you within the next two business days to let you know if you will be granted a scholarship for Student City Retreat 2022 August 19th-August 21st.
Student Name*

First NameLast Name
Parent Name*

First NameLast Name
Parent Phone number*

Area CodePhone Number
Parent E-mail*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
To determine scholarship eligiblility, we use a tiered system that coinsides with various government programs that are based off of income level. Even if you do not utilize these programs, please indicate which (if any) you qualify for as this determines your scholarship amount. Unsure of what you qualify for? See links below!*

SNAPTANF (Family first)State DisabilityFree or reduced priced lunch
Check out these links to see what different programs you qualify for!

1.SNAP: https://www.benefits.gov/benefit/1678

2.TANF Family first: https://www.tn.gov/humanservices/for-families/supplemental-nutrition-assistance-program-snap.html

3. STATE DISABILITY: https://www.tn.gov/humanservices/ds/disability-determination-services.html

4. Free Lunch or reduced priced lunch: https://www.tn.gov/education/health-and-safety/school-nutrition/free-and-reduced-price-meals.html
What background information could you provide to help us determine your qualifications for a scholarship?*
Please leave your signature below verifying that what you have said above is true: *

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