Needs-Based Scholarship Application

Applicant's Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

E-mail*

example@example.com

Phone Number*

Alternative Phone Number

Program you are interested in attending*

Program Cost*

Date of Program*

Please select the scholarship amount you would like to apply for*

Financial Need: Please describe your financial situation and why you need this scholarship in order to attend the program:*

Annual Household Income*

Size of Household*

If more applications are received than there are scholarships available for a specific program, priority will be given to those who are most in need of financial support and who show deep personal interest in our program. How do you hope it will help you and/or allow you to bring your gift into the world? *

*Scholarship applications will be reviewed and offers will be made once the minimum number of registered participants has been met*

Please note that in order to make scholarships available to the greatest number of families, we have implemented the following limitations. Each student may receive scholarships for one of the following:

One semester-long program per school year
Up to 5 single day programs per calendar year
One week of summer camp per year

Applicants may reapply one calendar year after their last application date. In order to share this opportunity with as many people as possible, priority will be given to first time scholarship applicants.

Note: Submission of a scholarship application does NOT automatically register a participant for a class/program or reserve a space in that class/program. In order to register, please call our office at 949-709-5777 or email info@earthrootsfieldschool.org. Please do not register online for a class/program if you are applying for a scholarship for that class/program.

I certify that the above information is accurate to the best of my knowledge.

Applicant Signature*

Today's Date*

Date

Earthroots Field School PO Box 504, Trabuco Canyon, CA 92678 info@earthrootsfieldschool.org

Earthroots Field School does not discriminate on the basis of race, color, religion, age, sex, disability, ethnic origin, or sexual orientation.

Earthroots Field School | PO Box 504, Trabuco Canyon, CA 92678 | 949-709-5777

Needs-Based Scholarship Application - ADULT