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Oakland Freedom School

Scholarship Form
Student Information
Full Name:
Last First M.I. Gender

School:
Current School Grade in Fall 12 Fathers Name Age Birthdate: Month/Date/Year Other Guardian

Guardians:
Mothers Name

Address: E-mail Address: Mom Cell ( )

City, Zip: Dad Cell ( )

Statement of Need
Write a statement detailing your situation and why you are requesting a scholarship:

Scholarship Request Amount


All registration fees fund supplies, afternoon and enrichment activities, field trips and graduation.

Partial support: $50 off$150 registration due I can pay half: $100 off$100 registration due Substantial support: $150 off- $50 registration due Full scholarship: $200 offNo fees paid (significant hardship)

In Kind Support
Are you available to volunteer at the site? Are you willing to help get donations to support the school? Are you willing to support the parent workshops? Would you like to help organize the parents? Yes Yes Yes Yes No No No No

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