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Hope Haven Scholarship Application
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* Required
Parent Information
First Name:
*
Your answer
Last Name:
*
Your answer
Address:
*
Your answer
City:
*
Your answer
County:
*
Your answer
Phone Number:
*
Your answer
Email:
*
Your answer
Applicant Information
Child's First Name:
*
Your answer
Child's Last Name:
*
Your answer
Age:
*
Your answer
Current School:
*
Your answer
Academic Program Information
Name of individual / center providing assitance:
*
Your answer
Mailing address:
*
Your answer
Phone number:
*
Your answer
Email address:
*
Your answer
Scholarship Amount
Date of Appointment
*
MM
/
DD
/
YYYY
Full cost of Evaluation
*
Your answer
Requested Scholarship Amount:
*
Your answer
Other Information:
*FULL scholarship requirements: (Please email verification to
Hollie.Gomenberg@dsfflorida.org
)
If you are requesting a FULL scholarship you MUST select the program you are submitting proof of)
Free or reduced lunch (current verification letter from your county's Food and Nutrition Services
Head Start enrolled student and siblings
Temporary Assistance for Needy Families (TANF)
Food stamps (copy of current awards letter and card)
Women, Infants & Children (WIC) program (current two-sided card)
My foster child is receiving state or local funding (copy of court documentation)
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*
I am a member of The Foundation.
Required
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