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Scholarship Traditional Application

  1. JCPRD Form Center Header

  2. Scholarship Application


  3. To apply for a scholarship, please provide all of the information requested below. Missing information or documentation will delay a determination of your eligibility. Please call us if you have any questions.

  4. Bars 2

  5. Enter one (1) parent/guardian name.

  6. Enter one (1) parent/guardian name.

  7. Separate by comma.

  8. Foster children do not require income verification. Note "Foster Child" and include a copy of the court documentation.

  9. Family Member Information

    In this section, please list names and ages of family members residing in your household and receiving support from your family income.
    (These individuals must be listed on your income tax forms unless born during the current year.)

  10. For this section, you must provide ALL of the following documentation:


    1. First two pages of prior year's Federal Income Tax Forms.
    2. W-2's supporting the income shown.
    3. If self-employed, copies of your Schedule C and 1099s supporting your income.
    4. Copies of other Schedules showing any additional income.
    5. Two most recent paycheck stubs for anyone in household over the age of 18 with earned income.
    6. Proof of residency (Utility Bill).

    You may scan, photograph, or screenshot these documents if they are not electronic.

  11. If you do NOT have a way to upload these files...

    If you don't have access to the electronic versions of the Free or Reduced Lunch Award Letter or Proof of Residency, you may fax them to (913) 831-6336.

    Or, you may bring to the address below:

    6501 Antioch Road
    Merriam, KS 66202

  12. Other sources of income requiring additional information:


    1. Interest, dividends, and other net income of any kind from real or personal property.
    2. Unemployment benefits, severance pay.
    3. Welfare Assistance.
    4.Social Security.
    5. Annuities.
    6. Retirement or pension funds and Insurance Policy, Disability, or Death Benefit payments.
    7. Net income from operating a business.
    8. Show amounts received and include documentation in the designated field below.

  13. Show amounts received and include documentation for the following (if applicable)

  14. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

  15. Scholarship term runs from January 1st to December 31st of the current year. New application and documentation is required each year.

  16. Leave This Blank:

  17. This field is not part of the form submission.