2022-23 Scholarship Application Scholarship Application Form Aspire Education is dedicated to ensuring that all Bay Area students have access to the extra academic support they need to succeed. We offer a limited number of scholarships each year and assign scholarships based on household income, household size, and financial need. The 2022-23 scholarship is targeted for students in grade 7 and below who are below grade level in math or reading. The deadline to submit the scholarship application is AUGUST 22, 2022. The Spring 2023 due date is December 30, 2022. Llena el formulario en español Student First & Last Name Student School Student Grade Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade 7th Grade Subject of Tutoring Reading Math Student GPA Parent or Guardian First & Last Name Relationship to Student Email Address Address Address Address City City State/Province State/Province Zip/Postal Zip/Postal Country Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Bulgaria Burkina Faso Burundi Côte d'Ivoire Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Croatia Cuba Curacao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Saint Barthelemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Country Phone Preferred Method of Contact Email Cell Phone Home Phone Work Phone OtherOther What scholarship period are you applying for? Fall 2022 (Aug-Dec) Spring 2023 (Jan-June) What scholarship period are you applying for? Aspire Scholarships operate on a sliding-scale basis. Please indicate below: The maximum amount that you are able to pay for tutoring The number of sessions you think you will need (Most students choose to do weekly tutoring. There are about 15 weeks in each semester) This is not a guarantee that we will be able to match this price, or that we will be able to provide the amount of sessions you need at this price. We ask this because we want to be able to accommodate as many families’ scholarship needs as possible. What is the maximum you would be able to pay for tutoring? $10-20 $20-30 $30-40 $40-50 $50-60 $60-70 $70-80 $80-90 $90-100 $100-110 Number of tutoring sessions you believe you will need this semester. 0-5 5-10 10-15 15+ Number of Dependents Number of people in household contributing income Total household income, for example, Line 43 on your Form 1040. Please enter numbers and decimals only, so $40,000.50 should be entered as 40000.50. Financial need Please explain why your family is requesting a scholarship. Provide any pertinent details that aren’t covered elsewhere on the application. Tutoring Location We offer both in-person and virtual tutoring. Please let us know if you have a strong preference for one or the other, and why. Personal statement * Tell us why your child would benefit from working with an Aspire Education tutor, and provide any relevant information regarding your child’s study skills and motivation. Please provide the context for your child’s grades and why your child is behind grade level in math or reading. What are your goals for your child in receiving this tutoring? Signature Submit