R.U.B.I.E.S. Scholar Application

Business Name

Home
About
Contact

Facebook
Twitter
LinkedIn

Tel. 123-456-7890
500 Terry Francine St.

Proudly designed by Your Name

Website Design by K&P Design Studio

D.A.R.L.N. Donations is a registered 501(c)(3) nonprofit organization. All donations are tax-deductible to the extent permitted by law.

First name

Last name

Phone

Address

Relationship to student

Student Information

Emergency Contact Name & Phone Number

Student Name

First and Last Name

DOB

Month

Day

Year

Age

Grade Level

School

City/State

GPA

Program Commitment Agreement

My daughter can commit to weekly sessions.

My daughter will complete assignments.

I understand attendance is required.

I understand this is an educational leadership program.

Why do you want to be part of R.U.B.I.E.S.?

What is one goal you have for your future?

What does leadership mean to you?

What is something you want to improve about yourself?

Please upload recent headshot

Please upload most recent report card.

Signature

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.

I understand that all fees are non-refundable once accepted into the program question,

Yes

Founding Cohort Investment: $699 Includes curriculum, workshops, activities, recognition, and banquet participation

$699