HELP Diagnostic Scholarship Application

HELP Program Diagnostic Scholarship Application

To qualify for a HELP Program Diagnostic Scholarship, individuals must schedule their testing with the Marshall HELP Program Diagnostician 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 or put on a payment plan with our Business Manager. Upon submission, the HELP Program Team will review your application and email you regarding award decisions as soon as possible.

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

H.E.L.P. Contact and Updates

For more information: