Scholarship Application

Parent Name*

First NameLast Name

Childs Name

First NameLast Name

Birth Date*

MonthDayYear

Who resides in the home with the child?*

What does your child need to improve on academically mentally socially emotionally? Please be specific.*

What is your child's temperament?

What is your child's favorite thing to do?*

Are there any other acomdations your child (ren) may need?*

Email*

example@example.com

Cell Phone*

Format: (000) 000-0000.

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Occupation*

Upload Proof of Income

I have a open case with DCPP

YESNO

Are you receiving SNAP or TANF?

YESNO

Are you receiving Program for Parents?

YESNO

I agree that the information above is accurate and truthful.
I agree that if the information has been found to be falsified I will lose the finacial assistance and I will repay what TEACH Academy has provided thus far.
I agree to upload current paystubs for my entire household
I agree to provide proof of income for my entire household.
I understand that financial asistance is only given once during the duration my child attends TEACH Academy
I agree if finacial assitanc is recieved my child will remain thrghout the entire school year

Date*

Date

Signature*

TEACH Scholorship Application