Chess4Life Scholarship Application
* Required
Student & Family Contact Information
What Chess4Life program are you requesting a scholarship for?
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Your answer
Name of Student Applicant
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Your answer
School
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Your answer
Student Date of Birth
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Your answer
Parent / Guardian Name
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Your answer
Student Email
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Your answer
Parent / Guardian Email
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Your answer
Home Address
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Your answer
City
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Your answer
State
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Your answer
Zip Code
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Your answer
Primary Phone Number
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Your answer
Secondary Phone Number
Your answer
Chess Experience Information
How long has your student played chess?
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Your answer
What is your students chess rating?
Your answer
How many tournaments has your student played in?
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Your answer
Please list any other chess accomplishments, awards, or honors:
Your answer
Financial / Need Information
What is your family's annual income?
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Your answer
Is your student in the School Lunch Program?
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YES
NO
If Yes, what percentage?
Your answer
What is the expected fee for the Chess4Life program you would like to attend?
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Your answer
What portion of tuition / fees can you reasonably pay?
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Your answer
Description
Please describe the reason(s) behind your scholarship request.
Description
Your answer
Certification
By entering my name below I certify that the information I have provided is true and correct.
Parent / Guardian Signature
*
Your answer
Date
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Your answer
Submit
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