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Youth Scholarship Application Form

Applicant Details

All fields marked with a '*' must be completed in order to submit an application.

Name *

Street Address *Must be a physical address, not a PO Box.

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Email Address *

Date of Birth *

Have you had any previous instruction in Tai Chi?YesNo

In 250 words or less, please tell us why you would like to learn Tai Chi? *0 / 250

Class You Would Like to Attend *

We ask you to complete the following details for statistical/demographic purposes ONLY. Your answers in no way determine your eligibility for the scholarship.

Gender Identity *

Preferred Pronouns

Racial/Ethnic/Cultural Identity *

Please Describe

Submission

I have read and understood the Wisconsin Tai Chi Academy Youth Scholarship Criteria document: *YesNo

I am 18 years of age or older at the time of making this application: *YesNo

You will need to obtain consent from your parent/legal guardian to submit this application. Please ask them to check the consent box below. We will contact all parents/guardians to confirm their consent has been obtained.

Parent/Legal Guardian's Name *

Parent/Legal Guardian's Preferred Contact *

Email Address *

Phone *

Parent/Legal Guardian's Consent *

As the parent/legal guardian named above of the applicant, by checking this box I hereby consent to their submission of this application and understand that I will be contacted to verify my consent.