Scholarship Form | DailiesFoundation

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Applicant Information

Name *

First

Last

Email *

Phone *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

What is your child's name? *

How old is your child? *

What is your child’s current educational setting? *

Public School
Private School
Homeschool
Charter School
Other

What grade is your child currently in? *

Does your child have an IEP (Individualized Education Program) or 504 Plan? *

Does your child have a learning difference or special needs diagnosis? If so, please specify. Choose as many as you like *

None
ADHD
Autism
Developmental Delay
Dysgraphia
Dyslexia
Gifted
Speech Delay
Other Neurodivergence
Other

What is your annual household income? *

Less than $25,000
$25,000 - $50,000
$50,000 - $75,000
$75,000 - $100,000
More than $100,000

How many dependents are in your household? *

Are you currently receiving any financial assistance (e.g., state funding, other scholarships)? *

Please briefly describe your current financial situation and why you are requesting this scholarship. *

How do you believe this scholarship will benefit your child's education? *

What are your child’s biggest educational challenges right now, and how are you currently addressing them? *

How do you plan to use the scholarship funds? (Select all that apply) *

Personalized tutoring
Special education services
Online classes
Behavioral or therapeutic interventions
Learning tools and materials
Other (please specify)

consent briefly your

Please share your family’s story and explain why this scholarship is important to your child's education. *

How do you envision this scholarship impacting your child’s educational future? *

What are your child's strengths and passions, and how do you hope this scholarship will help nurture them? *

Do you consent to have your story and application reviewed by the scholarship committee? *

Would you be willing to share your experience (anonymously or with your consent) for future Dailies Foundation promotional materials? *

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Agreement *

I agree

In checking this box, I am agreeing that all of the information provided in this application is true to the best of my knowledge, and that I am the author of all answers.