LetsChangeLives Scholarship Application Form
Counselor / School Info
School Name
Counselor Name
Counselor Email
Counselor Phone Number
Student Information
Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
E-mail
Enter E-mail Here
Mobile Phone Number
Format: (000) 000-0000.
Home Phone Number
Format: (000) 000-0000.
Student Pathway
What are the student’s plans after graduation?
Type a question
College
Trade School
Entrepreneurship
Military
Undecided
Brief explanation, from student if undecided.
0/600
COUNSELOR RECOMMENDATION
How has this student demonstrated: growth, resilience, accountability, or determination?
Please explain why you have chosen to nominate this student for the Let’s Change Lives Scholarship recipient.
In your response, please share how this student has demonstrated growth, resilience, determination, leadership, accountability, or personal transformation. We encourage you to highlight any obstacles the student has overcome, positive progress they have made, and why you believe they deserve this second-chance opportunity.
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