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*
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*

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Guardian Signature (if under 18)

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Name of Applicant*

First NameLast Name
Date Signed by Applicant*

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

Official high school transcript or GED certificateLetter of acceptance from your educational institutionProof of college enrollment and tuition payment with minimum 12 credit hours OR proof of enrollment and tuition payment to trade school programProof of Little Haiti residency (utility bill, lease, driver's license, high school registration form, etc.)Copy of ID card or driver's licenseProof of guardianship (birth certificate or legal document) - if under 18 years of age
File Upload

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Scholarship Application