HELP Diagnostic Scholarship Application

HELP Program Diagnostic Scholarship Application

To qualify for a Diagnostic HELP Scholarship, individuals must schedule their testing with the Marshall HELP Program Diagnostics Coordinator and submit the $100 deposit to the HELP Program Business Manager. They must also be in “good standing” with the HELP Program (meaning any prior bills have been paid). Once submitted, HELP Program Business Manager, Brett Jones, will reach out to you in regard to your application status.

Who is requesting funding?(Required)

First Last

Name of individual being testsed:(Required)

First Last

Parent/Guardian Name 1(Required)

First Last

Parent/Guardian Name 2(Required)

First Last

Permanent Address(Required)

Street Address Address Line 2 City State ZIP Code

Primary Phone(Required)

Primary Email(Required)

Have you scheduled with the HELP Program Diagnostics?

Yes

What type of evaluation(s) are you seeking?

Achievement testing

Intelligence (IQ) testing

ADHD evaluation

Full battery of testing

Unknown

Please indicate the number of people living in your home:

Please indicate your family annual income:

Residence

I own my own home.

I rent my home

Please indicate why you are requesting Scholarship Funding from the HELP Program.

HELP Program Diagnostic Scholarship Application

HELP Contact