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IMPORTANT COVID-19 AND DOWN SYNDROME INFORMATION
Global Down Syndrome Foundation
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2019 Dare to Cheer CU Scholarship Application
2019 Dare to Cheer CU Scholarship Application
2019 Dare to Cheer CU Scholarship Application
Name of Applicant
*
Birth date
*
Gender
*
Male
Female
Legal Guardian Name
*
Phone Number
*
Email Address
*
Address
*
Address
Address
Address
City
City
State/Province
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Zip/Postal
Name of School Applicant Attends (if applicable)
*
Current Grade
*
Does Applicant receive special services in the school or work
*
Yes
No
Please explain
*
Total Household Income
*
$0 - 9,999
$10,000 - 19,999
$20,000 - 29,999
$30,000 - 39,999
$40,000 - 49,999
$50,000 - 59,999
$60,000 and up
Number of dependents under the age of 21 living in household
*
Please explain any other circumstances that might qualify the applicant for scholarship (e.g., unexpected reduction of income; deployment of parent/guardian; medical expenses, etc.)
What scholarship option are you requesting?
*
Full Scholarship ($25)
50% Scholarship ($75)
75% Scholarship ($40)
I certify that all the information provided on this form is accurate to the best of my knowledge.
*
Signature
Date
*
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