Balot Family Scholarship Application

Page 1 of 5 - Student's Information

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Student's Information
Has the student been accepted to JPII? *
Name Name * First Last
Preferred Name *
Date of Birth Date of Birth * / MM / DD YYYY
Grade for 2018-2019 School Year *
Current School Name *
Grade Applying For: *
Address Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Religion *

Religion I am a member of a Catholic church. I am not a member of Catholic church.
Church Name
Ethnicity *

Ethnicity Hispanic or Latino Not Hispanic or Latino
Race (check all that apply): *

Race (check all that apply): Asian American Indian / Native Alaskan Black / African American Hawaiian / Pacific Islander White Two or more races
Save my progress and resume later
Enter Your Email Address *

A special link to resume the form will be sent to your email address.