Membership Scholarship Application

indicates a required answer

This form is for SJHA returning members or potential new members that are in need of a full or partial scholarship to offset their annual $40 membership dues.

1. *	Parent First and Last Name:

2. *	Parent Email:

3. *	Parent Phone Number:

4. *

List all students names and ages.

(format: Name, Age. Example: Jane, 9)

5. *

Are you requesting a full or partial scholarship?

FULL ($40)		PARTIAL ($10) - I can pay $30
PARTIAL ($20) - I can pay $20		PARTIAL ($30) - I can pay $10

6. *	Please explain your financial need or hardship.

7. *	Are you currently volunteering with SJHA? If yes, In what capacity are you volunteering?

If no, are you willing to volunteer?

Yes

9. *

Scholarship Terms & Conditions

All personal information provided by applicants will be treated confidentially and used solely for the purpose of assessing eligibility for the scholarship.

Your ability for applying for future scholarships will be terminated if you abuse our scholarship program. An example of abuse includes, but is not limited to, failure to follow SJHA's group policies.

Please note that applying for a scholarship does not guarantee approval. You may be granted all, some, or none of the amount you request. You will be notified of scholarship status via email.

By sining here you certify that the information you submit is accurate.

By typing my name below, I understand and agree that this form of electronic signature has the same legal force and effect as a manual signature.