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 *
Age *
Grade in School *
Area of Limitations *
(please be as specific as possible)
Name of Responsible Parent *
Address Line 1 *
Address Line 2
City *
State *
ZIP Code *
Country *
Phone Number *
(with area code)
Email Address *
Dates of White Sulphur Springs Camp *
Names and Ages of Family Members Attending White Sulphur Springs Camp *
Total Cost to Family for White Sulphur Springs Camp *
Brief Description of Why Child and Family Would be a Good Candidate for a Hillary Fund Scholarship *
Applicant Information
Name of Person Completing This Application *
Relationship to Child *
Address
Address Line 1
Address Line 2
City
State
ZIP Code
Country
Phone Number
Email Address *
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 *
Email Address *
Phone Number *
Relationship to Potential Recipient *
Name of Reference 2 *
Email Address *
Phone Number *
Relationship to Potential Recipient *
Name of Staff Member at White Sulphur Springs *
Email Address *
Phone Number *
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.