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Scholarship Application
jthibodeaux
2023-04-28T14:20:41-05:00
Student Information
Child's Full Name
*
Age
*
Previous School Attended
*
Date of Birth
*
Current Grade Level
*
Gender
*
Male
Female
Current School
*
Student Medical Information
List any chronic illnesses, allergies, and/or medications
Date Tested
Diagnosed as
Has your child been diagnosed with any learning disabilities?
*
Yes
No
Facility where tested
Has your child had any psychological or emotional issues?
*
Yes
No
Does your child have a 504 plan, IEP, or other?
*
Yes
No
Other
I don't know
If so, please explain.
*
Briefly tell us why your child should be chosen for the scholarship program and why do you want them to attend eLearning Academy?
*
Do you want to add a second child?
*
Yes
No
Child's Full Name
*
Age
*
Previous School Attended
*
Date of Birth
*
Current Grade Level
*
Gender
*
Male
Female
Current School
*
List any chronic illnesses, allergies, and/or medications
Date Tested
Diagnosed as
Has your child been diagnosed with any learning disabilities?
*
Yes
No
Facility where tested
Has your child had any psychological or emotional issues?
*
Yes
No
Does your child have a 504 plan, IEP, or other?
*
Yes
No
Other
I don't know
If so, please explain.
*
With whom does the child applying for the scholarship resides with?
*
Both parents
Mother
Father
Other (Step-Parent, Grandparent, Legal Guardian)
Mother's First Name
*
Mother's Cell Phone
*
Mother's Last Name
*
Mother's Email
*
Marital Status
*
Single
Married
Separated
Divorced
Widowed
How many children reside in the household:
*
Ages of Children:
*
Father's First Name
Father's Cell Phone
Father's Last Name
Father's Email
Marital Status
Single
Married
Separated
Divorced
Widowed
How many children reside in the household: (Skip if previously answered)
Ages of Children: (Skip if previously answered)
Does he and/or she have legal guardianship of the child?
*
Yes
No
State
*
Guardian's Full Name
*
City
*
Address
*
Zip Code
*
Financial Information
Mother's Occupation
*
Employer or Business Phone
*
Employer or Business Name
*
How Long Employed?
*
Father's Occupation
*
Employer/Business Phone
*
How Long Employed:
*
Employer or Business Name
*
Guardian's Occupation
*
Employer/Business Phone
*
How Long Employed:
*
Employer or Business Name
*
Are you able to provide the last 3 years worth of tax returns?
*
Yes
No
I verify that all information declared is true and that any false information will disqualify my child from the scholarship. I also know that I must upload any supporting documentation for eLearning Foundation to verify.
*
I understand
Submit
Having trouble submitting? Call us at
(985) 447-5994
or email
scholarships@elearningk12.com
.
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