Scholarship Application

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Student's Name

First

Middle

Last

Student's Birthdate 00/00/0000

Student's Last Grade Completed

Academic Year of Application

Mother's Name

First

Last

Father's Name

First

Last

Main Phone Number (000) 000-0000

Parent's Email Address

For which scholarship are you applying?

I will be sending the following documentation:

After submitting this application, you will be sent a link to upload the needed documents. Ezra Taft Benson Scholarship: Student’s academic records/transcript for the past three years. David O. McKay Scholarship: Copy of a recent Income Tax Return.

Have you submitted an enrollment application?

A non-refundable fee of $50 must be paid before a student will be considered for a scholarship. This fee can be applied to the $100 application fee.

Is your child receiving other education funding?

Will your child be receiving any other state or locally funded scholarship or assistance through organizations such as Harmony Education? Please name the organization, if any.

Why would you like your child to attend Experius Academy?

Parent or Student Comments

Do you have any additional information you would like to add that you feel would be important for us to know when considering your application?

I Certify:

I certify that all information submitted, or that will be submitted for scholarship consideration, is accurate and true to the best of my knowledge, and that any false statements can result in withdrawal of the scholarship.

I Agree:

I agree that if I am granted a scholarship, I will pay the full year’s tuition for the academic year that the scholarship was granted.