EJ Achiever Tutoring Scholarship Application

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* 1. Student First Name:

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* 2. Student Last Name:

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* 3. Student Email Address: (If your student does not have an email address, one will be provided for him/her.)

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* 4. School:

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* 5. What grade will your student be in next school year (2016-2017)?

5

6

7

8

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* 6. Sex:

M

F

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* 7. Guardian First Name:

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* 8. Guardian Last Name:

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* 9. Guardian Email Address: (If you do not have an email address, one will be provided for you.)

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* 10. Guardian Phone Number:

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* 11. Alternate Phone Number:

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* 12. Current Mailing Address:

Address

City/Town

State/Province

ZIP/Postal Code

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* 13. If your student is awarded the scholarship, what is the best method to contact you?

Phone

Email

Both

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* 14. If you selected phone, which phone number and what days/times are most convenient to call?

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