Fitwize

Scholarship Form

Scholarship Form for Fitwize 4 Kids

Child’s Name

Child’s Age

Parent’s/Legal Guardian Name

Household Address

City

State

Zip Code

Household Phone Number

Does your child receive free school lunch? Y / N

Yes

Does your child receive reduced school lunch? Y / N

Yes

Household Composition (You may be required to provide documentation of household):

Name

Age

Gender

Relationship

Household Income (Please provide supportive documentation for all listed income including employer contact information as applicable):

Income Source

Annual Amount

Document