SCHOLARSHIP APPLICATION

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

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.

Child's Name *

Parent(s) Name(s) *

Email Address(s)

Best Contact Phone Number *

JHLP Program (select one) *

Phase I

Phase II

Cost of Program *

Phase 1 $500

Phase 2 $700

Total Funds Requested *

Provide a brief explanation of your reason for requesting assistance: Please note additional information may be requested. *

Organizational Referral Name and Phone #

I certify that all of the information submitted in this form is true *

YES

Required

Name of Person Completing Form *

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Teton Youth and Family Services. Report Abuse

Forms