SCHOLARSHIP APPLICATION

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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 (non subsidized cost: $846) (subsidized cost: $400)

Phase II (non subsidized cost: $2000) (subsidized cost: $1000)

TAP (non subsidized cost: $3000) (subsidized cost: $2000)

Total Funds Requested (we ask all families to contribute some portion of the total cost) *

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

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

YES

Required

Name of Person Completing Form *

Submit

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