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AN IMAGE OF ME

SCHOLARSHIP APPLICATION
FAMILY INFORMATION
FINANCIAL HARDSHIP INFORMATION

Examples of financial hardships include:

Multiple choice
Job loss or reduced income
Single income household
Multiple dependents in the home
Multiple choice

STUDENT INTEREST STATEMENT

OPTIONAL INFORMATION
How much of the $120 program fee can your family contribute at this time.
$0
$25
$50
$75
Other
FAMILY COMMITTMENT
If awarded a scholarship, we understand our daughter is expected to
Attend program session regularly
Participate respectively and actively
Follow program guidelines and expectations
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Date
Month
Day
Year
SCHOLARSHIP AWARD NOTIFICATION

Applications will be reviewed based on demostrated financial needs and the student's interest in participating in the program. Award decisions will be communicated confidentially.


Thank you for your application and investing in your daughter's future.


Penelope Carr

contact@animageofme.org

704-574-6299

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