LHRT Scholarship Application Form

Scholarship Application
Mission:

The Little Haiti Revitalization Trust Scholarship Program supports residents of Little Haiti in achieving their educational goals by providing $2,500 per student to help reduce barriers to higher education and vocational training. Applications are reviewed on a first-come, first-served basis.
Name

First NameLast Name
Email
example@example.com
Phone Number
Format: (000) 000-0000.
Date of Birth

MonthDayYear
Date
Current Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Educational Information
Name of High School Attended
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Year Graduated
Date Expected to Graduate

MonthDayYear
Date

Acknowledgement & Signature
I certify that the information provided in this application is true, complete, and accurate to the best of my knowledge. I understand that providing false or misleading information may result in disqualification from consideration or termination of any scholarship awarded.
Applicant's Signature
Guardian Signature (if under 18)
Name of Applicant

First NameLast Name
Date Signed by Applicant

MonthDayYear
Date
Please make sure the following is included with your application (attach below):
File Upload

Cancelof
I agree to receive communications via text and email
I agree to receive communications via text and email
Should be Empty:

Scholarship Application