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Work Entry
Request a Scholarship
Student First Name
Student Last Name
Student Grade (2022-23 school year)
5th Grade
6th Grade
7th Grade
What Campus Does Your Student Attend?
Berks
Clarks Summit
Coal Township
Columbia-Montour
Dickson City
Ephrata
Hanover
Harleysville
Harrisburg
Hazleton
Lancaster City
Lebanon
Manheim
Northern Dauphin
Online
Waynesboro
West Schuylkill
West Shore
Wilkes-Barre
York
Parent First Name
Parent Last Name
Parent Phone Number
Parent Email Address
Reason for Scholarship Request
What amount will you be able to contribute to your student's $325 ticket to Wildfire?
Does your student regularly attend Collide?
No
Yes
Does your student serve at LCBC?
No
Yes
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