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IMPORTANT NEW RESOURCE FROM THE AMERICAN ACADEMY OF PEDIATRICS2022 Health Supervision for Children & Adolescents with Down Syndrome
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
Alabama
Alaska
Arkansas
Arizona
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State/Province
Zip/Postal
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
*
Submit