SCHOLARSHIP APPLICATION
The Jackson Hole Leadership Program provides scholarship opportunities for children who are in need and qualify financially. To be eligible for a full or partial scholarship, please complete the following information sheet. All information will remain confidential.
Child's Name *
Your answer
Parent(s) Name(s) *
Your answer
Mailing Address *
Your answer
Email Address(s)
Your answer
Best Contact Phone Number *
Your answer
Alternative Phone # *
Your answer
JHLP Program (select one) *
Cost of Program *
Your answer
Total Funds Requested *
Your answer
Provide a brief explanation of your reason for requesting assistance: *
Your answer
Organizational Referral
Your answer
Organizational Contact Name
Your answer
Referral Contact Phone #
Your answer
I certify that all of the information submitted in this form is true *
Required
Name of Person Completing Form *
Your answer
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