Blosser Center Tutoring Scholarship Application
Thanks to a generous donation, the Blosser Center has been able to establish a pool of scholarship funds for our 2021-2022 tutoring. To be considered for a scholarship, please complete the information requested below. For questions regarding our scholarship program, please contact our Executive Director, via email at

Our scholarship committee will review applications monthly. Awards will apply to 2021-2022 sessions delivered after September 1, 2021. Please note that the Center will not be able to fund all requests for support that are received.
Student Name: *
Student Gender (Optional):
Clear selection
Student Race (Optional):
Is your student currently being tutored by the Center? *
How long has your student received tutoring from the Blosser Center? *
How long do you anticipate your student tutoring with the Blosser Center? *
Parent/Guardian Name: *
Phone: *
Email: *
Does your child qualify for free/reduced lunch via your school? If yes, please email a copy of the approval letter from your school to our Executive Director at *
Each tutoring lesson is billed at a rate of $80.00, beginning 9/1/2021. In order to serve as many students as possible, scholarships will generally not be awarded for the full cost of the lessons. What percentage, would you be able to contribute towards tutoring? *
If you selected less than 50% per lesson to the above question, please indicate the amount you believe you could contribute.
Please (briefly) describe any additional information that you feel would be helpful for the committee.
I understand that providing false or misleading information on any part of this application will disqualify me from any current or future tuition support. *
Parent or Guardian Signature *
Type your full name below. Your name indicates your acceptance of the terms of this application.
Date *
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy