Live Conference Scholarship (GROUP FORM)

Date*

Time*

: HH

MM

Are you a Parent or a Youth and Young Adult Organization? (If PARENT fIll out PARENTS SECTION)*

OTHER

"PARENT'S SECTION"

Parent's Name

First Last

Phone

Email

Please Place the NAME, AGE, SCHOOL, PHONE NUMBER and EMAIL ADDRESS of your 5 or more youth below.

Please check all the answers below that apply to the applicants you are applying for.

They receive the lunch assistance program at school
They live in a single parent household where the earnings are less than $40,000 a year
They live in a dual parent household where the earnings are less than $60,000 a year
They are currently in foster care/separated from parents
They are wards of the state
None of these apply
These children need Live Conference Scholarships for other reasons. (PLEASE FILL OUT SECTIONED MARKED "OTHER' BELOW TO EXPLAIN)

OTHER

"YOUTH AND YOUNG ADULT ORGANIZATION SECTION"

Name of Organization

First

Organization's Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Website

Your Name

First Last

Your Title

Phone

Email

Who in your organization will be paying for the discounted tickets?

Name

First Last

Phone

Email

How many Youth and Young Adults does your organization need scholarships for?

How will your organization be paying for the discounted tickets?

Other form of payment

Please briefly explain the social or economical challenges the youth and young adults in your organization experience and why you feel they need sponsorship for this Live Conference.

How did you hear about us/ Who referred us to you?*

Live Conferences Scholarships (GROUP FORM)

Live Conferences Scholarships (GROUP FORM)