2020-21 Youth Enrichment Scholarship Form

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One to One Mentoring provides special scholarship assistance to Mentees for local sports and enrichment activities. If your Mentee is interested in participating in a special program, community activity or sport and can demonstrate financial need, please complete this application.

YOUTH NAME *

FAMILY/ PARENT/ GUARDIAN NAMES *

FAMILY PHONE NUMBERS *

FAMILY MAILING ADDRESS *

YOUTH INVOLVEMENT IN ONE TO ONE MENTORING *

Currently matched with a Mentor

Was previously matched. Waiting to be rematched.

On the Waitlist

Other:

ANNUAL FAMILY INCOME (January to December) *

QUALIFIES FOR THE FREE/REDUCED LUNCH PROGRAM? *

Yes

Other:

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