Youth - Scholarship Form (English)

Please complete this form to apply for a scholarship for any MDPC Youth event.  One application per child.  One application per event.

If you have any questions, please contact Charlotte Adams at cadams@mdpc.org or 713-953-2553..

*Address Line 1
Address Line 2
*City
*State/Province/Region
*Zip/Postal Code
*Applying for a scholarship for what MDPC Youth event:
*Event Date:
*Who is completing this application:
*Congregation:
*Total Cost of Event:
*Participant's First Name:
*Participant's Last Name:
*Participant's Date of Birth:
*Participant's Cell Phone:
*Participant's Email Address:
*Participant's Street Address:
*City, State, Zip Code:
*Parent/Guardian First Name:
*Parent/Guardian Last Name:
Parent/Guardian Date of Birth:
*Parent/Guardian Cell Phone:
*Parent/Guardian Email Address:
Parent/Guardian Address if different from Participant's:
*Scholarship Options (please choose one):
*Payment Plan Options (please choose one):
*Method of Payment (please choose one):
*Why do you believe it is important for your youth to attend this event:
*Please describe the situation that causes your need at this time: