Hope Restored Scholarship Application

Please allow for 20-30 minutes to finish your scholarship and have your Federal Tax Return ready for upload at the end of the form, Black out all social security numbers.

Your Contact Information

First Name

Enter a name that is at least two characters long. (Characters can be letters of the alphabet, an apostrophe, hyphen, space, or period.)

Last Name

Enter a name that is at least two characters long. (Characters can be letters of the alphabet, an apostrophe, hyphen, space, or period.)

Email Address

Mobile Phone number

Please enter your area code, followed by your phone number, mobile phone preferred. Please use numbers only, no dashes or other separators.

Your Spouse's Contact Information

First Name

Enter a name that is at least two characters long. (Characters can be letters of the alphabet, an apostrophe, hyphen, space, or period.)

Last Name

Enter a name that is at least two characters long. (Characters can be letters of the alphabet, an apostrophe, hyphen, space, or period.)

Email Address

Mobile Phone number

Please enter your area code, followed by your phone number, mobile phone preferred. Please use numbers only, no dashes or other separators.

Your Street Address

Address Line 1

Address Line 2

Address Line 3

City

Please enter a city name that is at least two characters long. (Characters can be letters of the alphabet, an apostrophe, hyphen, space, or period.)

State

Province

State / Province / Region

Zip Code

Postal Code

Zip or Postal Code

Country

Family Information

Number of Dependent Children:

1st Child's First Name

Enter a name that is at least two characters long. (Characters can be letters of the alphabet, an apostrophe, hyphen, space, or period.)

1st Child's Age

2nd Child's First Name

Enter a name that is at least two characters long. (Characters can be letters of the alphabet, an apostrophe, hyphen, space, or period.)

2nd Child's Age

3rd Child's First Name

Enter a name that is at least two characters long. (Characters can be letters of the alphabet, an apostrophe, hyphen, space, or period.)

3rd Child's Age

4th Child's First Name

Enter a name that is at least two characters long. (Characters can be letters of the alphabet, an apostrophe, hyphen, space, or period.)

4th Child's Age

5th Child's First Name

Enter a name that is at least two characters long. (Characters can be letters of the alphabet, an apostrophe, hyphen, space, or period.)

5th Child's Age

6th Child's First Name

Enter a name that is at least two characters long. (Characters can be letters of the alphabet, an apostrophe, hyphen, space, or period.)

6th Child's Age

7th Child's First Name

Enter a name that is at least two characters long. (Characters can be letters of the alphabet, an apostrophe, hyphen, space, or period.)

7th Child's Age

8th Child's First Name

Enter a name that is at least two characters long. (Characters can be letters of the alphabet, an apostrophe, hyphen, space, or period.)

8th Child's Age

9th Child's First Name

Enter a name that is at least two characters long. (Characters can be letters of the alphabet, an apostrophe, hyphen, space, or period.)

9th Child's Age

10th Child's First Name

Enter a name that is at least two characters long. (Characters can be letters of the alphabet, an apostrophe, hyphen, space, or period.)

10th Child's Age

Income Information

What is the division of income between spouses for the tax year submitted?

You

Your Spouse

Does either spouse own a business?

YesNo

If Yes, please include a copy of Schedule C from your most recent tax year when submitting your documents at the end of this form.

What amount, if any, did you receive in non-taxable income for the prior tax year (disability insurance, pension, retirement, or social security income)?

Other Information

Are there any extenuating financial circumstances that you feel should be considered in the determination of a scholarship?

Hope Restored Scholarship Application

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