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2. Parent/Guardian Name*
4. Participant Name*
5. Birthdate
6. Age*
8. Home Address*
10. Grade*
11. Gender*
12. Home/Cell Phone*
14. Email*
15. Do you now or have ever recieved a youth scholarship? *
17. Please submit proof of one of the following documents (must include published child’s name)

    1. Proof of enrollment in GUSD/GPS free or reduced-price meals program (preferred)
    2. California Head Start letter
    3. First 5 of Santa Clara County
    4. Food Stamps eligibility letter (CalFresh)
    5. Medi-Cal eligibility letter
    6. Proof of foster child care.
    7. Women, Infants and Children (WIC) Program
19. Proof of Scholarship Document *
21. Initial for Confirmation *
23. Date of Submission*
    Date of Submission

25. Scholarship participants must be 17 years old or younger to qualify. Please note, in case of a refund, the scholarship will be refunded fully before any funds are returned to the customer (per class).

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27. 1. Receive an email copy of this form.
28. Email address

    This field is not part of the form submission.

29. Submit

* indicates a required field