Hope Restored Scholarship Application Form
Applicant Information
Names:
Address:
City / State / Zip:
Husband Cell: Husband Email:
Wife Cell: Wife Email:
Family Information
Name(s) and Age(s) of dependent children in the home:
Financial Information
Combined annual income from line 7 of 1040 Tax Form (adjusted gross income):
Please include a copy of the page of last year’s tax return which includes line 7 with all social
security numbers blacked out.
Are there any extenuating circumstances that you feel should be considered in the determination of a
scholarship?