Texas Chargers Retreat Scholarship Application 2024

Scholarship Application
Name of person with CHARGE attending

First NameLast Name
Name of person completing application

First NameLast Name
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
How many guest plan to attend in your party?
Scholarship amount applying for

$125$250
Reason for applying

It is a hardship to cover registrationNot on a waiver programOther
On a waiver program (MDCP, DBMD, CLASS) and have contacted my Case-Manger

YesNo
My HHSC Case-Manager's Name
My HHSC Case-Manager's Phone Number
I have contacted my local school district

YesNoNot in school
I have reached out to local organizations ie: Lions Clubs, ect.

YesNo
Please let us know any information you think we should know.
Eligibilty: All current Texas Residents affected with Charge Syndrome or Texas "families" are eligible for scholarships/financial aide providing Texas Chargers, Inc. Board of Directors approves and funding exists.
Should be Empty: