Family Scholarship Application

Apply for the Family Scholarship through Juvenile Uplifting Mentor Program to support education and uplift young minds. Together, we empower brighter futures for families in need.

Full Name

Address

City, State, Zip Code

Phone Number

Relationship to Juvenile(s)

Full Name

Date of Birth

School

Grade Level

Full Name

Date of Birth

School

Grade Level

Full Name (if applicable)

Date of Birth

School

Grade Level

Please check all that apply

Financial Hardship Multiple Children Applying Other

Explain why your family needs financial assistance to participate in JUMP

Describe how your family and the juveniles will benefit from participating in JUMP

Number of Adults in the Household

Annual Household Income

Under $25,000 $25,000–$50,000 $50,000–$75,000 Over $75,000

Parent/Guardian Signature

Date

I certify that the information provided in this application is true and accurate to the best of my knowledge. I understand that this scholarship application does not guarantee acceptance into the program or approval for financial assistance.

Yes

J.U.M.P.

Family Scholarship Application

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Contact Information

Serving Counties

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