The Jackson Hole Leadership Program provides scholarship opportunities for children who are in need and qualify financially.  To be eligible for a full or partial scholarship, please complete the following information sheet.  All information will remain confidential.
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Child's Name *
Parent(s) Name(s) *
Email Address(s)
Best Contact Phone Number *
JHLP Program (select one) *
Cost of Program *
Total Funds Requested *
Provide a brief explanation of your reason for requesting assistance: *
Organizational Referral Name and Phone #
I certify that all of the information submitted in this form is true *
Name of Person Completing Form *
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