Scholarship Application Form
Student Information
Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Grade Level (applying for or currently enrolled)
*
School the student will attend:
*
Kids Academy Lighthouse
Kids Academy Special Education
Other
Please select the type of assistance you are applying for:
*
Tuition Assistance – Help with monthly or annual school tuition payments.
Scholarship – Financial support based on family need and student learning differences.
Books – Assistance with the cost of printed or digital learning materials.
Technology – Support for devices or tools needed for educational access.
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Parent/Guardian Information
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Relationship to Student
*
Father
Mother
Legal Guardian
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Diagnosis or Special Educational Needs
Does the student have a diagnosed condition or special educational need?
*
Yes
No
Prefer not to answer
If yes, please select all that apply (Note: This information is confidential and used only to better understand and support the student's needs.)
Autism Spectrum Disorder (ASD)
Attention Deficit Hyperactivity Disorder (ADHD)
Intellectual Disability
Learning Disability (e.g., dyslexia, dyscalculia)
Speech or Communication Disorder
Visual Impairment
Hearing Impairment
Cerebral Palsy
Other
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Household Financial Information
Total number of people in the household:
*
Number of working adults
*
Number of children under 18
*
Monthly gross household income
*
Approximate annual household income
*
Sources of income (check all that apply)
*
Employment
Self-employment
Public assistance (SNAP, TANF, Medicaid, etc.)
Child support or alimony
Other
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Required Documentation
Attach at least one of the following (required):
*
Most recent tax return (IRS Form 1040)
Pay stubs (last 2–3)
Public benefit award letter
Sworn income statement
Required Documentation
*
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Personal Statement (Optional but Encouraged)
Briefly explain why you are applying for this scholarship and how it would benefit your family:
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Additional Required Documents (Based on Scholarship Type)
All documents must be current, legible, and match the applicant and student information.
A. Proof of Florida Residency
Submit two different documents from the list below (for the same guardian):
*
Utility bill (electricity, gas, water)
Mortgage statement or lease agreement
Florida driver’s license or state-issued ID
Insurance policy statement (auto, health, home, renters)
Current government benefit letter (SNAP, TANF, HUD, Medicaid, etc.)
Address verification letter from a Migrant Program or Homeless Liaison
*
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B. Proof of Student's Age
Submit one of the following:
*
Birth certificate
Valid passport
*
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Social Security Number
Note: If unavailable, this section may be left blank.
Parent/guardian and student’s Social Security Numbers (if available)
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Diagnosis Documentation (For Special Needs Scholarships Only)
Required only if applying for a special needs scholarship (e.g., FES-UA).
Medical, psychological, or APRN report stating the student's diagnosis
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Proof of Income (For Low-Income Priority)
Note: Without income documentation, your application will be reviewed without income-based priority.
*
Pay stubs from the last 30 consecutive days
Documentation of other income (child support, unemployment, Social Security, etc.)
*
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Applicant Declaration
*
I declare that all information provided is true and complete.
I authorize Kids Academy Foundation to verify this information if necessary.
I understand that providing false information may result in the loss of any awarded scholarship.
Signature
*
Date
*
-
Month
-
Day
Year
Date
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