Scholarship Form

Date: ___________
Parent’s Name: __________________________________________
Boy’s Name: ____________________________________________
Address: ______________________________________________________________
Phone: (home) ___________________ (work) ________________________
(other) ___________________

Name of the person who introduced you to the Boys to Men? ____________________

All information hereafter is confidential and will be used for scholarship consideration only.

What is your total monthly income? ______________________________
What are your total monthly expenses? ____________________________
Are you a veteran, minority, or legally disabled? Please specify. ___________________
________________________________________________________________________
How much of a scholarship do you request? ___________________________________
________________________________________________________________________
Do you need a payment plan? _______
When can you begin?______________________________
What do you suggest?______________________________________________________
Is there any thing else you would like us to know as we consider your request?

We assume that only persons who truly need financial assistance will apply for it. Be aware that you may not receive the amount of scholarship you request. Scholarship assistance is arranged by the BTM-MN board of directors and cannot be granted or promised by any other member of the BTM-MN.

I, _____________________________, state that all the information on this form is true to the best of my knowledge.

Signed: ________________________________ Date: ________________________

Please call if you have any questions.

Thanks.