Scholarship Application
Misty Meadows is committed to keeping our programs affordable for all students who would benefit from our services. Please complete the application below to help our scholarship committee to understand your needs.
Contact Details
Student Name
Date of Application
Parent/Guardian # 1 Information
This information is not applicable to me
First Name
Last Name
Best Phone Number
Email Address
Mailing Address
City
State
Please select...
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Puerto Rico
Virgin Island
Northern Mariana Islands
Guam
American Samoa
Palau
Zip Code
Marital Status
Married
Single
Widowed
Divorced/Separated
Other
Parent/Guardian #2 Information
This information is not applicable to me
First Name
Last Name
Best Phone Number
Email Address
Address
City
State
Please select...
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Puerto Rico
Virgin Island
Northern Mariana Islands
Guam
American Samoa
Palau
Zip Code
Have you applied for a scholarship before?
yes
no
Are other members of your family applying for scholarship assistance?
yes
no
If yes, what is the name of the family member.
Which Session(s) or activity does the student(s) want to participate in?
Fall Session
Winter Session
Spring Session
Summer Session
Mini Camp
Equine Assisted Learning Experience
Other
Number and ages of other children in household.
Please list other people living in the household.
Student resides with:
Parent/Guardian #1
Parent/Guardian #2
Both Parent/Guardian #1 and #2
Self
Other
What other activities and/or therapies does the student participate in? How often?
Please describe any circumstances that contribute to the need for scholarship support.
Financial Information
The following information is required and is maintained as confidential information. Please list all forms of income received on an annual basis. Mark N/A for any that do not apply to you.
Wages
Alimony
Interest from Savings
Welfare
Social Security
Pension/Retirement
VA Benefits
Insurance Benefits
Medicaid
Respite Care
Unemployment
Workers Comp
Child Support (Income)
Disability Payments
Spousal Support
Other
Total Income
Amount of scholarship requested:
25%
50%
75%
100%
By checking this box, I certify that the information provided in this application is correct, to the best of my knowledge.
Contact Information