DLA Scholarship Application

Student Name*

First NameLast Name

Birth Date*

MonthDayYear

Gender

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent E-mail*

example@example.com

Student E-mail

example@example.com

Parent Mobile Number*

Student Mobile Number

Is the student eligible for free or reduced-price school lunches?*

YesNo

Total annual household income:*

Upload photo of valid passport or recently submitted passport application. THIS IS MANDATORY TO BE CONSIDERED FOR A SCHOLARSHIP*

Sleeping arrangements for this trip are dorm-style, and segregated by gender. If this is untenable for your student (for example, for reasons of privacy), we ask that you do not apply. If you believe there may be concerns surrounding this, please type them below:

It is very important to honestly ask your student and yourself the following questions before applying: Does your student have a great interest in history? If not, please don't send them on this program. They will be learning leadership through history. It is an intense learning environment and requires attention.

Please type yes or no.

Are you as a parent and is your student committed to fulfilling pre-program informational requirements on time? It is mandatory and failure to do so can result in forfeiture of a scholarship to another student.

Please type yes or no.

Is your student committed to being 100% respectful at all times of other students and group leaders? Disrespect and disruption will not be tolerated. After one warning and/or a parental phone call the student can be sent home early at the parent's expense.

Please type yes or no.

Is your student able to be open minded about culture and especially food in France? We can make allowances for certain diets and allergies, but if your student won't be comfortable without access to familiar American food, this is definitely not the program for them. They will be eating traditional French dishes and learning about French customs. These are often Norman staples that include chicken, beef or pork, and potatoes, rice, etc. We will not be serving hamburgers or chicken nuggets. A program overseas is not the place for you if you will only eat these types of food.

Please type yes or no.

· The following guidelines MUST be adhered to on the program. If they are not, you risk being sent home early at your parent’s expense. Parents, please initial below that you understand and accept this code of conduct. · 1. Dress appropriately. Aside from the multi-weather gear you will bring, please know you will be visiting churches, schools, museums, and sometimes private residences. It is inappropriate to wear midriff-baring shirts or dresses. Torn clothing is not appropriate (and not functional in Normandy). · 2.You MAY NOT purchase or bring: Replica weapons of any kind. Lighters. Laser Pointers. Alcohol. · 3. Be respectful at all times to everyone you meet and program chaperones and employees. This is not negotiable. · 4. Boys and girls may not enter the dorm rooms of the other at any time for any reason. Ask a chaperone if you need to retrieve something. · 5. After lights out you must stay in your bed unless using the restroom. The kitchen and other parts of the house are off limits. If you are having trouble sleeping, contact a chaperone during the day. · 6. Unless given permission by group leaders you must stay with the group. This is done for your safety. You may not wander off on your own. This is considered disrespectful behavior and will be handled in the same manner.

DLA Scholarship Request Form