Rootead


Rootead Scholarship Request Form
First Name
Last Name
Are you requesting this scholarship for yourself or for a youth?
If you are requesting this scholarship for a youth, please enter their first & last name, and their age.
Address 1
City
State/Province
Zip
Phone
Phone Type
Email
Pronouns
Race & Ethnicity	Black Native American / Indigenous Latino / Chicano / Hispanic Asian Pacific Islander White Biracial / Mixed Prefer not to answer
Do you identify as queer/LGBTQIA+?
Are you a person with physical disabilities?
Which program are you requesting a scholarship for?
How many people are in your household?
Share the need for the scholarship: Why is it important to you to participate in this program?
How much of a scholarship are you seeking?
Scholarship recipients are asked to give feedback after the programs. Are you willing to do this?

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