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Student First Name
Student First Name is required.
Student Last Name
Student Last Name is required.
Student Gender
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Female
Student Gender is required.
Student Grade (2023-24 school year)
9th Grade
10th Grade
11th Grade
12th Grade
Student Grade (2023-24 school year) is required.
Parent First Name
Parent First Name is required.
Parent Last Name
Parent Last Name is required.
Parent Phone Number
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Parent Email Address
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Parent Email Address is required.
My Student Attends the Following Campus:
Altoona
Center Valley
Clarks Summit
Coal Township
Columbia-Montour
Dickson City
East York
Ephrata
Hanover
Harleysville
Harrisburg
Hazleton
Lancaster City
Lebanon
Leesport
Manheim
Northern Dauphin
Online
Pottstown
Sinking Spring
Waynesboro
West Schuylkill
West Shore
West York
Wilkes-Barre
Willow Street
My Student Attends the Following Campus: is required.
Reason for Scholarship Request
Reason for Scholarship Request is required.
What amount will you be able to contribute to your student's $75 ticket to HSM Impact?
What amount will you be able to contribute to your student's $75 ticket to HSM Impact? is required.
Does your student regularly attend HSM?
No
Yes
Does your student regularly attend HSM? is required.
Does your student serve at LCBC?
No
Yes
Does your student serve at LCBC? is required.
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