Scholarship Request Form
Due to the generosity of Seacoast Church, scholarships may be available to ensure that finances are not a barrier to care. To apply for assistance, please complete the scholarship application. All scholarships will be reviewed to determine how much financial assistance can be provided toward the standard hourly rate. A complete application, along with supporting documentation, must be submitted before a request can be reviewed. Please allow 7 business days for review. For your protection, all information is confidential. Scholarships are approved for 3 month terms and may be renewed with re-application.
Name
*
First Name
Last Name
Email
example@example.com
Please describe briefly why you are applying for financial assistance.
*
Do you attend a local church?
*
Yes
No
If yes, which church?
*
Tell us about your employment status.
*
Employed Full-Time
Employed Part-Time
Retired
Unemployed
Where do you work?
*
What is your estimated monthly income?
*
What are your estimated monthly expenses?
*
Please attach one of the following: current pay stub with YTD income; or your last 2 months of bank statements (full bank statements, not screenshots).
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