Teen Incentive Grants 2024-25

1. Teen Participant First Name *This question is required.

2. Teen Participant Last Name *This question is required.

3. Teen Participant Phone Number *This question is required.

4. Teen Participant Email Address *This question is required.

5. Teen Participant Mailing Address
Example:
Stacy Gerberchik
12345 Main St, Apt 6
Los Angeles CA, 91234 *This question is required.

6. Parent #1's First Name *This question is required.

7. Parent #1's Last Name *This question is required.

8. Parent #1's Phone Number *This question is required.

9. Parent #1's Email *This question is required.

10. Parent #2's First Name

11. Parent #2's Last Name

12. Parent #2's Phone Number

13. Parent #2's Email

14. Applicant Date of Birth *This question is required. This question requires a valid date format of MM/DD/YYYY.

calendar

15. Applicant's Grade in School *This question is required.

16. How did you hear about the grant? *This question is required.

Program Provider Information:

Checks will be made out and sent directly to the organization on behalf of the applicant.

17. Name of Program Provider *This question is required.

18. Program Provider Contact Name *This question is required.

19. Program Provider Phone Number *This question is required.

20. Program Provider Email *This question is required.

21. Name of Program/Event *This question is required.

22. Cost of Program *This question is required.

23. Dates of Program **The program must be at least 4 weeks away in order to receive the grant** *This question is required.

Start Date
End Date

If no, please list the programs you previously participated in, including the date:

If not, what program provider did you previously attend a program with?

Please allow at least one month prior to start date of program for the Incentive Grant Committee to process your application.