Scholarship Form

Reality Student Ministries Youth Scholarship Form Date:_________________________ Name:________________________________________Gender________Age:_______ Parents Names:_________________________________________________________ Address:_______________________________________________________________ City: ______________________________ State: _______________ Zip: ___________ Home Number: ______________________ Cell Number:_________________________ Event Applying for: ______________________________________________________ Agreement: I have filled out this form to the best of my ability. By filling out this form I am informing the Reality Student ministry staff that I need financial help in paying my registration fee. I have spoke with my parents about how much money they can contribute and also tried to earn as much money as possible to contribute to my fund. I will be responsible to attend all fundraisers for the event and save any extra money to pay towards my registration fee. If I do not attend fundraisers I will not receive any financial help. The money that I still need is: $__________ I can contribute: $___________ Parents can contribute: $___________ Students Signature: ___________________________ Parents Signature: ____________________________

Office Use Only Scholarships: Student- Approved ___ Rejected___ (check one) Amount Funded: $________ Amount Contributed by Student: $_________

Attended Fundraising: Yes___ No___ (check one)