CHOICES Scholarship Application

Student's First Name:
Student's Last Name:
Date of Birth:
Current Grade:
Current School:
School at which the scholarship will be used:
Parent/Guardian's Full Name:
Street Address:
City, State, Zip:
Daytime Telephone Number:
Evening Telephone Number:
E-Mail Address:
Family's Total Income:

Scholarships are awarded based on need. Describe the problems and challenges your student faces and how a CHOICES scholarship would be helpful to your child and/or family.

Please keep your essay between 500 and 1000 words

Lil Tuttle,
Education Director
ltuttle@cblpi.org
843-503-1318

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