PFCA Scholarship Application
Email address *
Student Name: *
Date of Birth *
ex: mm/dd/yyyy or 00/00/0000
MM
/
DD
/
YYYY
Student Social Security # *
Address *
Street/City/State/Zip Code
Gender *
Ethnicity *
Grade *
Full Name *
Relationship to Student *
Mailing Address *
Street/City/State/Zip Code or Same as Previous Address
Home Phone Number *
ex. 000-000-0000
Cell Phone Number *
ex. 000-000-0000
Family Income *
Number in Family *
Can you afford to pay a portion of the tuition? *
How much can you afford to pay? *
If a portion can be paid who will be responsible for the payment? *
Full Name
Address of person responsible for payment *
Address/City/State/Zip Code
Home Phone *
Cell Phone *
Relationship to Student *
Why do you want your child to attend Prevailing Faith Christian Academy? *
Submit
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