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Love Like Lyndsey Loved Scholarship Application

Student's full name

First Name

Last Name

Date of birth

YYYY

Home address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Mailing address (if different)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Telephone number

(###)

###

####

Email address

Parent or legal guardian's name

College(s) accepted or applied to

Career Goal

Entering a field focused on supporting the special needs community

Are you completing high school through the exceptional student education (ESE) program and planning to continue your education?

Name of high school

Current GPA

List of extra curricular activities involving special needs

Please email the following to giving@lovelikelyndseyloved.com

By clicking “I agree” you certify that all information on this application is accurate to the best of your knowledge.

By clicking “I agree” you understand that if you are awarded this scholarship, you must submit proof of enrollment from the college or university of your choice or the scholarship will be forfeited.

*All information will be kept confidential.