Centrally Rooted Scholarship Application -2024
Centrally Rooted is an inclusive space for supporting positive brain health development through creative expression. Currently, the application can be used for Rooted Lessons, Mindful Musicians, music therapy services, and any other services that are programmed by Centrally Rooted.
Sign in to Google to save your progress. Learn more
Email *
Name *
First and last name
Date of Submission *
MM
/
DD
/
YYYY
Phone number *
Which creative service(s) are you interested in? *
Required
Financial Request: Which area of financial need do you consider yourself?
Clear selection
Income: Based on your 2023 tax return, what income bracket does your household fall within?
Clear selection
Bridging to Home: How will you continue to support the efforts made at Centrally Rooted within your home?
Child(ren) information (Name and age)
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms