Make the Extra Pass Foundation
The Hooperverse Youth Basketball League
Scholarship Application Form
Child's Full Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Age
blank
*
Grade
blank
*
Child's Gender
*
Male
Female
Non-Binary
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Family Information
Parent 1
Parent Name
*
First Name
Last Name
Email
*
example@example.com
Home or Mobile Phone
*
-
Area Code
Phone Number
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent 2
Parent Name
First Name
Last Name
Home or Mobile Phone
-
Area Code
Phone Number
Other Children in the Family
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Additional Information
Monthly Family Income (Gross)
*
$
Additional Income
Income ($)
Welfare AFDC
Child Support
Support from Spouse
Social Security
Income from 2nd Job
Other
Total Additional Income
Total Monthly Income
*
Please Explain the Reasons for Need
We may contact you for additional information.
Submit
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