Scholar Application Form
Bridging generations through education and companionship
Student’s Name
Date of Birth
.
Month
.
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Today’s Date
.
Month
.
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Current Grade Level
Please Select
9th Grade
10th Grade
11th Grade
12th Grade
Name of Current/Upcoming High School
Student’s Phone Number (if applicable)
Format: (000) 000-0000.
Student’s Email
example@example.com
Parent/Guardian’s Name
Parent/Guardian’s Phone Number
Format: (000) 000-0000.
Parent/Guardian’s Email
example@example.com
Address
Emergency Contact’s Name
Emergency Contact’s Phone Number
Format: (000) 000-0000.
Emergency Contact’s Relationship to Student
Allergies
Back
Next
Please take your time to reflect and provide deep, thoughtful responses to the following questions.
1. Please list the name and relationship you have with other public (non-family) adults involved in your life (counselor, social worker, another agency, or nonprofit leader etc.):
2. Please explain what you are passionate about in life (what gets you excited about life?)
3. Please explain what kind of support you currently have for example a (family member, mentor, teacher, etc.)
4. Please tell us about the strengths that you have, everyone has them so dig deep to list something.
5. What challenges/big obstacles do you face that you feel hold you back? List as many as you can think of.
6. What makes you most happy in life gives you life? It can be similar to your passions or different.
7. What do you dislike or what frustrates you most in your life?
8. What is the hardest challenge or obstacle you have faced so far how did you respond overcome it? Or maybe you are still working on overcoming it so explain how you are working on that?
9. What are you hoping to get from Kinsella Angels that you do not already get?
10. What does your future look like? What do you currently see for your future the trajectory or path that you are on now?
11. What do you want your future to look like?
12. Where do you currently give in your life, community, family, friends, school, etc.? Where do you want to see changes or growth in your giving?
Preview PDF
Submit
Should be Empty: