Note: This scholarship is only available for students enrolled at Tussey Mountain High School.

Student's Name

Student's First Name

Student's Last Name

Parent's Name

Parent's First Name

Parent's Last Name

Contact Email

Daytime Phone

Youth's Gender

Home Address

Address

Address 2

City/Town

State/Province

- None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWashington DCWest VirginiaWisconsinWyoming

ZIP/Postal Code

Household Information

Number of adults in the home

Number of children in the home

Select any of the situations below that apply to your family

Free School Lunches

Reduced School Lunches

Medical Assistance

Other Government Assistance

CAPTCHA

Submit