Legacy in Motion Scholarship Application 📚✨

Legacy in Motion Scholarship Application 📚✨

Complete the form to apply for scholarship funding and support your educational or community goals.
Applicant Information
Full Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email Address*
example@example.com
Home Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
YesNo
Household Size*
Annual Household Income (USD)*
Youth Enrichment (K-12): Athletics, arts, music, dance, STEAM, extracurricular fees/equipmentSummer/Academic Support (Middle-High School): Camps, tutoring, summer schoolAdult Family Empowerment: College/trade school, certifications, or entrepreneurship (single parents, injured spouses, caregivers)
Program Details
Institution/Program Name*
Yes (attach proof below)No
Upload proof of accreditation (if applicable)

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Tuition/Fees (USD)*
Equipment (USD)*
Other Costs (USD)
Total Cost (USD, not to exceed $2,500)*
Upload cost quote/invoice*

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Upload FAFSA or other aid summary (if applicable)

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Eligibility (Adult Track Only)
Single parent/caregiverInjured spouse (attach IRS Form 8379 or approval letter)Other caregiver
Upload proof for eligibility (IRS Form 8379, approval letter, etc.)

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Full-timePart-timeUnemployedStudent
Personal Statement (200 words max): How will this funding support your or your child's growth, mental health, workforce entry, or community impact? Describe your goals and need.*
References
Reference 1 - Name*
Reference 1 - Phone or Email*
Reference 1 - Relationship*
Reference 2 - Name*
Reference 2 - Phone or Email*
Reference 2 - Relationship*
Certification & Authorization
Initial here if you authorize sharing your story/photo (optional)
Signature*
Date*

MonthDayYear
Date
Should be Empty:

Legacy in Motion Scholarship Application 📚✨

Applicant Information

Program Details

Eligibility (Adult Track Only)

References

Certification & Authorization