Student's Name
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First Name
Last Name
Email
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Student's Date of Birth
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DD
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This scholarship applies to February and March 2021 only. Trips are scheduled on every other Sunday from 2/7/2021 to 3/21/2021, a total of 4 trips on the following Sundays: 2/7, 2/21, 3/7, 3/21. Registration is required for all 4 trips. Current pick-up and drop-off stops are in Long Island City and Harlem. The fee for the trips of 2/7 and 2/21/2021 is charged at the time of registration (full fee is $320). The fee for the trips of 3/7 and 3/21/2021 is charged on 3/1/2021 (full fee is $320).
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I have read and I agree with the terms of the City to Sanctuary Scholarship
I do NOT agree with the terms of the City to Sanctuary Scholarship
Select your family's annual gross income in 2020
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Less than $25,000
$25,000 - $50,000
$50,000 - $75,000
$75,000 - $100,000
$100,000 - $125,000
$125,000 - $150,000
More than $150,000
Select level of scholarship requested
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Covers 25% of program fee
Covers 50% of program fee
Select your child's ethnicity
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African American
American Indian or Alaska Native
Asian
Hispanic
Native Hawaiian or Other Pacific Islander
White
Other
Prefer not to say
Does your child have any special needs of which we should be aware?
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Does your child have any medical issues of which we should be aware?
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If you have any questions or comments, please let us know here:
You will be notified of the status of your application within 48 hours. Please sign and date below.
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