Chess4Life Scholarship Application
Student & Family Contact Information
What Chess4Life program are you requesting a scholarship for? *
Name of Student Applicant *
School *
Student Date of Birth *
Parent / Guardian Name *
Student Email *
Parent / Guardian Email *
Home Address *
City *
State *
Zip Code *
Primary Phone Number *
Secondary Phone Number
Chess Experience Information
How long has your student played chess? *
What is your students chess rating?
How many tournaments has your student played in? *
Please list any other chess accomplishments, awards, or honors:
Financial / Need Information
What is your family's annual income? *
Is your student in the School Lunch Program? *
If Yes, what percentage?
What is the expected fee for the Chess4Life program you would like to attend? *
What portion of tuition / fees can you reasonably pay? *
Please describe the reason(s) behind your scholarship request.
By entering my name below I certify that the information I have provided is true and correct.
Parent / Guardian Signature *
Date *
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