Jordan's Safe Place Scholarship Application

Jordan's Safe Place Scholarship Application

Complete the form with your details, upload your transcript and recommendation, and submit your certified electronic signature.
Applicant Full Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address

Confirmation Emailexample@example.com
High School Name
Graduation Year
GPA
Intended College or Trade School
Intended Major or Career Field
Extracurricular Activities (clubs, sports, etc.)
Community Service Involvement
Jordan's Safe Place Scholarship Essay

In 750–1,000 words, describe how mental health has impacted your life, the life of someone you care about, or your community. Explain how this experience shaped your understanding of mental health, resilience, empathy, or self-care; how you plan to promote hope and mental wellness through your education, career, or community involvement; and why reducing the stigma surrounding mental health is important to you. You are not expected to disclose deeply personal experiences. Your essay will be evaluated on authenticity, reflection, and alignment with the mission of Jordan's Safe Place.
Jordan's Safe Place Scholarship Essay
Upload essay (optional)

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Leadership Experience
Honors and Awards
Personal Statement: Please explain your educational goals, challenges you have overcome, and how receiving this scholarship will make a difference.
Upload Unofficial Transcript

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Upload One Recommendation Letter

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Electronic Signature
Submission Date

MonthDayYear
Date
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Jordan's Safe Place Scholarship Application

Jordan's Safe Place Scholarship Essay