Scholarship Application

Please note that each member of the family is limited to the number of classes he/she can register for per class session at the discounted rate. That limit is currently one class and one workshop per session per individual. You may list an alternate class if your first choice is unavailable for any reason. As classes are subject to minimum/maximum capacities, failure to attend the first class without advance notice may result in forfeiture of your seat, and failure to attend class regularly may result in forfeiture of your award for the year.

Scholarship Application

Applicant Info
Applicant Name*
First Last
Spouse Name
First Last
Date of Birth*
MM slash DD slash YYYY
Date of Birth
MM slash DD slash YYYY
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Home Phone
Cell Phone
Email
Class/Workshop you will be taking.*
Dependent Info
Children
List all children & their birthdates.
Income
Please note: You must attach proof of income for the household. Acceptable forms include: 1040, 1040EZ, 1040NR. Only the cover page is needed to demonstrate gross and adjusted net income and household size. Amount of award is dependent on household size.
Source of Income is*
- Employment
- SSI
- SSDA
- Other
Annual Household Income*
Household Size
As shown on your federal return.
Income Verification*
Proof of income (for all members listed on federal income tax return). A copy of the first page of your federal income form (1040, 1040 EZ, 1040 NR) is preferred.
Drop files here or

Max. file size: 1 MB.
Statistical Information
Are you a Lawrence County Resident?
Race/Ethnicity
(Optional)
How did you hear about us?
Have you received tuition assistance before?
- Yes
- No

Scholarship Application

Scholarship Application

Applicant Info

Dependent Info

Income

Statistical Information