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Politisit Scholarship Application (Oregon)
Please provide the following information to apply for a childcare scholarship.  Once we approve your scholarship request, you will be able to request funding for specific events. At this time we are working with clients in Oregon.  We are hoping to expand to other states soon, so please let us know if you'd like us to be in touch at that time.
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Name *
Address *
Phone Number *
Email Address *
How many children will you usually need care for? *
What is your babysitter's usual rate? *
Which do you prefer to receive funds? *
What types of civic engagement are you interested in attending? *
Is there anything else you would like us to know about your scholarship application?
How did you hear about us? *
Please answer the following demographic questions to assist us in our work.  
When seeking funding for Politisit to assist clients, this information is often important in applications to donors or for receiving grants.  We also want to ensure we know which communities we are and are not serving well, in order to improve.  Politisit is committed to maintaining your privacy.  Thank you.
What is your gender? *
Do you consider yourself to be:
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What is your age range? *
What is your ethnicity? *
Required
What is the highest degree or level of school you have completed? If currently enrolled, highest degree received. *
What is your marital status? *
Do you consider your home to be located in an area that is: *
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