The Hillary Fund Scholarship Application
The application should be completed in the name of the child or children with special needs or limitations. Scholarships will be granted in consideration of the entire family.
Name of Child *
Your answer
Age *
Your answer
Grade in School *
Your answer
Area of Limitations *
(please be as specific as possible)
Your answer
Name of Responsible Parent *
Your answer
Address Line 1 *
Your answer
Address Line 2
Your answer
City *
Your answer
State *
Your answer
ZIP Code *
Your answer
Country *
Your answer
Phone Number *
(with area code)
Your answer
Email Address *
Your answer
Dates of White Sulphur Springs Camp *
Your answer
Names and Ages of Family Members Attending White Sulphur Springs Camp *
Your answer
Total Cost to Family for White Sulphur Springs Camp *
Your answer
Brief Description of Why Child and Family Would be a Good Candidate for a Hillary Fund Scholarship *
Your answer
Applicant Information
Name of Person Completing This Application *
Your answer
Relationship to Child *
Your answer
Address
Address Line 1
Your answer
Address Line 2
Your answer
City
Your answer
State
Your answer
ZIP Code
Your answer
Country
Your answer
Phone Number
Your answer
Email Address *
Your answer
References
Please list two references, other than family members, who are fully acquainted with the potential recipient. At least one of the references should be the recipient's teacher, principal and/or minister. A third reference is requested from a staff member at White Sulphur Springs.
Name of Reference 1 *
Your answer
Email Address *
Your answer
Phone Number *
Your answer
Relationship to Potential Recipient *
Your answer
Name of Reference 2 *
Your answer
Email Address *
Your answer
Phone Number *
Your answer
Relationship to Potential Recipient *
Your answer
Name of Staff Member at White Sulphur Springs *
Your answer
Email Address *
Your answer
Phone Number *
Your answer
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