Core Class Scholarship Form – Leadership Lancaster

Core Class Scholarship Request Form

Completed scholarship request forms must be submitted online by May 24, 2024.

Your Name*

First Last

Business/Organization*

Title*

Email*

Household income*

$30,000 or under
$30,001 - $60,000
$60,001 and over

Family*

Number of dependents and ages

Anticipated sources of support for tuition*

Select All
Employer
Self
Community Organization
House of Worship
None
Other

Check all that apply

I have asked my employer/organization to support my Core Class tuition*

Amount of employer/organization contribution*

Amount of assistance sought

Scholarship request*

Scholarship Fund*

Please select the Scholarship Fund you are requesting a scholarship from

How much will you personally contribute?*

Minimum $150

A payment plan option is available in which tuition is paid over an extended period of time. Are you requesting this option?*

Describe any special circumstances that should be considered in your request for tuition assistance:*

(Maximum two paragraphs)

Any additional comments?

(2 paragraph limit)

Scholarship requirements

 All recipients must pay $150 of the tuition fee within four weeks of acceptance in order to hold their place  Recipients must agree to the attendance policy  If the program is not completed for any reason, the scholarship must be repaid in full.

Name*

First Last

I understand and agree to the above requirements

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Core Class Scholarship Form.

Amount of assistance sought

Scholarship requirements

Search the Leadership Lancaster website