Life History Scholarship Application
MN Residents ONLY
Your Name
*
First
Last
Phone
*
Format: (000) 000-0000.
Email
*
example@example.com
Date of Birth
*
-
Month
-
Day
Year
Date
How old are you now?
*
Please Select
Under 18
18
19
20
21
22
23
24
25
26
27
28
Over 28
Must be under 31 to get foster care records.
Race (check all that apply)
*
African American/Black
American Indian/Native Alaskan
Asian/Pacific Islander
White
Other
Hispanic Heritage?
*
Yes
No
Gender
*
Male
Female
Other
Why do you want to start this now?
*
Medical questions, reconnecting with family or friends, specific curiosity, get information to save for late
Who are your support people?
*
Anyone you trust to be in your life for the next few years, has YOUR best interests at heart, and is willing to help you through this process
What types of information do you want to search out?
*
Medical Information
Photos
Foster Care File
Contact Information For Specific People
School Records, IEP/504/etc.
Immunization Report
Vital Records - SS Card, Birth, Death, Marriage, Divorce Certificate
Therapy Records + Evaluations
DNA Testing
Other
People we can reach out to (and contact info) who may have information or photos you want
*
Example: Aunt Julie, 763-098-2424, example@example.com
People or time periods would you would like photos of
Example: Baby photos of me, pictures of my mom
Vital records are you interested in
Example: My birth certificate pre-adoption or my parents marriage certificate
People you'd like to connect with but don't have contact information for
Example: My fifth grade teacher Ms Jones from Johnsonville Elementary in MN
Schools you've attended and for what grades
Example: South High School, St Paul, 9-11 grades
Physical Health doctors, hospitals, clinics you've seen
Example: Born at HCMC, treated at Allina
Mental Health therapists, doctors, hospitals and clinics you've seen
Example: Saw a therapist a Fraser, his name was Robert Jones
MN County (or counties) that handled your family's foster care case, and any workers you remember
Example: Dakota County, Billy Brown was my social worker
Submit - And sign up for a one-on-one meeting with Alisa
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