RIMH Inc. Financial Support Application
PERSONAL DATA
Full Name
*
First Name
Middle Name
Last Name
Birth Date (Applicant must be between the ages 16 to 23)
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a year
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Year
Place of Birth
*
State of Origin
*
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Format: (000) 000-0000.
E-mail
*
example@example.com
Guardians Name (if under 18 years of age)
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
INSTITUTION/PROGRAM INFORMATION
FILL OUT NAME OF INSTITUTION OR PROGRAM YOU'RE APPLYING FOR
Name of Desired Institution or Program
*
Address of Institution or Program
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Course
*
Duration of Course
*
Award in view
*
Funding Needed
Session of Admission
*
Start Date
Admission Type
*
Please Select
Full Time
Part Time
Online
Other
Education
*
Please Select
Currently Enrolled in High School
High School Diploma or GED
College Degree/Some College
Other
Upload proof of High School Diploma or GED certificate
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Volunteer Hours
*
Browse Files
Drag and drop files here
Choose a file
Upload signed verification letter(s) from organizations
Cancel
of
Letters of Recommendation
*
Browse Files
Drag and drop files here
Choose a file
Upload three signed letters (PDF/DOC) from mentors, teachers, or community leaders
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of
Personal Essay
*
Browse Files
Drag and drop files here
Choose a file
A 500–750 words essay detailing your vision, purpose, short-term goals, and long-term goals
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of
Acknowledgment & Agreement
*
Please Select
Yes
No
I confirm all information provided is accurate.
Digital Signature
*
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