Harbor Youth Scholarship Application
Student Name
*
First Name
Last Name
Student's Grade
*
Parent Name
*
First Name
Last Name
Parent Phone Number
*
Please enter a valid phone number.
Parent Email
*
example@example.com
Which HY event are you applying for?
*
Please Select
HY Middle School Winter Retreat ($215)
HY High School Winter Retreat ($215)
HY South Dakota Mission Trip ($550)
Other
How much money are you requesting?
*
Submit
Should be Empty: