Bucks For Kids Scholarship Application

Submission #:
Scholarship Application
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

Clear
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:
Should be Empty: