* Required

Parent Information

First Namerequired

Last Namerequired

Phonerequired

Emailrequired

Active Military or First Responder?*

Active Military First Responder

Student Information

First Namerequired

Last Namerequired

2020-21 Grade Levelrequired

Do you have more than one student?*

Yes No

First Name

Last Name

2020-21 Grade Level

First Name

Last Name

2020-21 Grade Level

First Name

Last Name

Current Grade Level

Applicants must be active military or active first responder (law enforcement, firemen, and paramedics).
Applicants must be able to provide any and all requested documentation.
Applicants must provide a copy of military ID or orders. First responders must provide a copy of current check stub.

Acknowledgement*

I have read and understand the “Eligibility Criteria” section of this application.

Acknowledgement*

I understand that this 25% discount cannot be combined with any other need-based tuition assistance.

Certification*

I certify that all of the information provided is accurate and true.

Please send a confirmation email to the address below*: