# Scholarship application

Source: https://backpr.com/resources/templates/scholarship-application. Last updated: 2026-10-19.

A short, respectful application for families who need help paying. Keep every answer confidential.

Free download: PDF https://backpr.com/media/templates/backpr-scholarship-application.pdf · Word https://backpr.com/media/templates/backpr-scholarship-application.docx · Spanish PDF https://backpr.com/media/templates/backpr-scholarship-application-es.pdf

> Your answers are private. Only the people who review scholarships will see them. We'll let you know our decision by: ____________

**Family**
- Parent or guardian name: ______
- Phone and email: ______
- Children applying (names and ages): ______

**Programs**
- Program and session for each child: ______
- Full price for each child: ______

**Household**
- Number of people in the household: ______
- Annual household income (a range is fine): ______
- Does your family receive public benefits, such as SNAP, WIC or Medicaid? (optional): ______

**Request**
Check one.
- [ ] Full scholarship
- [ ] Partial scholarship
- [ ] Payment plan only
- Amount your family can pay (in total, or per month): ______
- Anything else you'd like us to know (optional): ______

**Confirmation**
- The information above is true to the best of my knowledge. Parent or guardian signature: ______
- Date: ______

**For office use only**
- Decision and amount awarded: ______
- Reviewed by and date: ______

### How to use it
- Tell families when they'll hear back, and keep that promise.
- Limit who sees applications to the people who review them.
- Decide your sliding scale before applications come in, so decisions are consistent.
- Pair it with our scholarship policy template.

**What should a scholarship application ask?**
Who's applying, which programs, household size and income (a range is fine), what the family can pay and anything else they want you to know. Keep it short and respectful.

**Do we need proof of income?**
That's your choice. Many programs accept a family's word or ask for proof only for full scholarships. Whatever you choose, apply it the same way to everyone.

Free to use and change, but not legal or medical advice. Check your state's licensing rules and your insurer's requirements, and have a lawyer review any consent or waiver language.