Chess4Life Scholarship Application

Student & Family Contact Information

What Chess4Life program are you requesting a scholarship for?

This is a required question

Name of Student Applicant

This is a required question

School

This is a required question

Student Date of Birth

This is a required question

Parent / Guardian Name

This is a required question

Student Email

This is a required question

Parent / Guardian Email

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Home Address

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City

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State

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Zip Code

Must be a number between 1 and 99,999

This is a required question

Primary Phone Number

This is a required question

Secondary Phone Number

This is a required question

Chess Experience Information

How long has your student played chess?

This is a required question

What is your students chess rating?

This is a required question

How many tournaments has your student played in?

This is a required question

Please list any other chess accomplishments, awards, or honors:

This is a required question

Financial / Need Information

What is your family's annual income?

This is a required question

Is your student in the School Lunch Program?

This is a required question

If Yes, what percentage?

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What is the expected fee for the Chess4Life program you would like to attend?

This is a required question

What portion of tuition / fees can you reasonably pay?

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Description

Please describe the reason(s) behind your scholarship request.

Description

This is a required question

Certification

By entering my name below I certify that the information I have provided is true and correct.

Parent / Guardian Signature

This is a required question

Date

This is a required question