Basic Information
Are you applying as:
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If applying on behalf of a student or organization, please provide name and role:
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Financial Information
Please describe your current financial situation and why paying the full $1,200 program fee is a challenge for you or your organization:
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If you are an organization, what is the maximum amount you or your organization can currently contribute toward the program fee?
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Are you currently receiving any government assistance or financial aid? (Check all that apply)
{"type":"checkbox","name":"__generic8","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please make a selection for this item.","options":"SNAP\nMedicaid\nFree or Reduced School Lunch\nTANF\nOther (please specify):"}
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Have you received funding or scholarships from other organizations in the past 12 months? If yes, please describe:
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Environmental and Cultural Context
Please describe any challenges your community or family faces related to access, culture, or environment that this program could help address:
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Why is this mentorship program important for you or your students at this time?
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How do you see this program supporting your growth or the growth of your students?
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Commitment & Readiness
Are you or your organization able to commit to attending all 12 sessions over the 6-month cohort?
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{"type":"textarea","name":"__generic15","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":""}
Do you have reliable access to the necessary technology and/or physical space to participate?
Select1. Yes2. No (please explain){"type":"select","name":"__generic3","width":40,"value":"","size":"Normal","validation":"N1","validationMessage":"Please make a selection for this item.","options":"Select\n1. Yes\n2. No (please explain)"}
{"type":"textarea","name":"__generic17","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":""}
Are you willing to provide feedback during and after the program to help improve Tilled Soil offerings?
Select1. Yes2. No{"type":"select","name":"__generic7","width":25,"value":"","size":"Normal","validation":"N1","validationMessage":"Please make a selection for this item.","options":"Select\n1. Yes\n2. No"}
Additional Information
Is there anything else you would like us to consider regarding your application?
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Agreement and Disclosure
{"type":"checkbox","name":"__generic20","width":100,"value":"","size":"Normal","validation":"C1","validationMessage":"Please check at least one item.","options":"I certify that the information provided in this application is true and accurate to the best of my knowledge. I understand that scholarship awards are limited and based on need and alignment with program goals. I acknowledge that Tilled Soil may request documentation or proof of any financial assistance or aid claimed in this application to verify eligibility for the scholarship program."}
Signature:
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