EJE Memorial Fund Scholarship Form
Student Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Gender
Male
Female
Grade Level
*
Current School Name (If applicable)
List of Attended Schools
Rows
School Name
School Year
1
2
3
4
5
6
How much funding are you requesting for the 2026-2027 school year?
*
Please Select
$200
$400
$600
$800
$1000
$1200
$1400
$1600
$1800
$2000
$2000
$2500
All funds awarded will be given in scholarship form to The Learning Habitat, LLC in the name of the child listed above.
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Parent Information
Father's Name
First Name
Last Name
Father's Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Mother's Name
First Name
Last Name
Mother's Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Have you applied for the EJE Memorial Scholarship before?
*
Please Select
Yes
No
Annual household pre-tax income
*
Please note that EJE Memorial Fund scholarships are need-based.
Please upload the portion of your 2024 Tax Return that shows all income.
*
Browse Files
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Choose a file
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Please provide a reason why are you applying for a scholarship.
*
Please indicate below why we should choose you or grant you this scholarship.
*
Applicant Signature
*
Date Signed
*
-
Month
-
Day
Year
Date
Submit
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