Scholarship Application Form

Please Note: Families may only request one scholarship per class. Scholarships rarely cover the entire cost of the class. Payment plans are also available.

Name of Clinic(required)

Name of Student (required)

Student's DOB (required)

Name of Parent (required)

E-Mail (required)

Phone (required)

Best time to contact you

Do you qualify for free/reduced lunch or other public assistance program?
Choose OneFree/Reduced LunchOther Public AssistanceNone

What range do you feel comfortable contributing to class cost? (i.e., 25% to 75% of class cost, or dollar amount)

Brief description of your circumstances