SCHOLARSHIP APPLICATION FORM

SCHOLARSHIP APPLICATION FORM

This confidential form is for applicants who are underprivileged and cannot afford to pay for the enrichment program. Please fill out the form to determine your eligibility.
Guardian's Full Name*

First NameLast Name
Email Address
example@example.com
Scholarship Applicant Full Name*

First NameLast Name
Parent's Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Why do you want to participate in the DO Boxing Academy?
Is the scholarship applicant currently enrolled in school ?*

YesNo
If Yes ( explain grades, attendance, and behavior as it relates to school )
Does the scholarship applicant work?*

YesNo
If yes ( explain work situation )
Do you currently receive any of the following assistance programs? (Check all that apply)

Free or Reduced Lunch ProgramSNAP (Food Stamps)MedicaidHousing AssistanceOther (please specify)
Other ( please specify )
What is your total household income? (Optional, but helpful for assessment)

Under $25,000$25,000 - $50,000$50,000 - $75,000Over $75,000
What is your current financial situation?
What is the age of the scholarship applicant?*
Has the scholarship applicant faced challenges related to the criminal justice system that you believe this program could help with?
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