Empowerment Scholarship Eligibility Questionaire
Part 1 - Student Information
Student's Full Name
*
First Name
Last Name
Current Grade Level
*
Current School Attending
*
Does your child have an IEP, MET, or 504 plan?
*
Yes
No
Quest1 Score:
Was your child adopted or in Foster Care?
*
Yes
No
Quest2 Score:
Does your child attend a D/ F public school?
*
Yes
No
Quest3 Score:
Part 2 - Parent Information
Are you currently a resident of Arizona?
*
Yes
No
Quest4 Score:
Are you currently an active member in the Military?
*
Yes
No
Quest5 Score:
Parent's Full Name
*
First Name
Last Name
Email
*
Phone Number
*
-
Area Code
Phone Number
Total Score
Submit
Should be Empty: