Bucks For Kids Scholarship Application

Submission #:

Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Email

example@example.com

Phone Number

Area CodePhone Number

Date of Birth*

MonthDayYear

High School*

Caseworker Name

Your education to date.*

(example: High School, College, etc.)

High School Grade Point Average*

List your extracurricular activities, student activities and interests. Be specific.

State your Employment History:

State your Career Goals:

State how you plan to achieve these goals:

Have you received a Bucks For Kids Scholarship before? *

YesNo

List Colleges, Trade Schools, etc. where you have applied:

Tell us why you want the Scholarship, including specifics of other Grants and Scholarships awarded:*

Tell us what Bucks County Children and Youth can do to improve services:

Signature

Caseworker Portion

(fill out below section if applicable)

Case Number:

(ex. community, special needs, day or night)

How long has student been known to Children and Youth:

(ex. community, special needs, day or night)

Placement:

(ex. community, special needs, day or night)

Other Funding Sources:

State why this Scholarship should be granted: