Youth Programs: Scholarship & Payment Plan Application
Please use this form to apply for a scholarship or payment plan for Wise Fool youth programs.
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Student's Name *
Parent/Guardian Name *
Parent/Guardian Email Address *
Paren/Guardian Phone Number
What are you applying for? *
What program are you applying for? *
Required
What is your family's annual household income? *
How many people are in your household? *
Do you receive financial assistance from other sources (i.e. grandparents, trust fund, etc.) *
Are there specific circumstances that make it difficult to pay for the program? (i.e. illnesses, unexpected expenses)
Are you in need of other support? *
Required
Would you like to meet to go over options through Unite Us? *
Wise Fool is part of the Unite Us network, which is comprised of community health workers, volunteers, and social workers who link people to services and resources in our community. We can help connect residents to resources within a cohesive provider network. Social, economic, and physical environmental resources are available to all New Mexico residents.
Wise Fool is committed to social justice and equitable practices, therefore it is important for us to know your race/ethnicity. Please help us by self-identifying.
If you are applying for a scholarship, what is the maximum portion of the program fee you are able to pay? (you can use the matrix below to help get a sense of the suggested amount)
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If you are applying for a payment plan, please describe how you would like to make your payment.
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