Please complete this application to apply for the scholarship program electronically for the April 1, 2024-April 1, 2025 term. 

You must reside in Olathe to be eligible. You must submit a copy of your 2023 Federal Income Tax Return for income verification. 

If you prefer, you may complete a paper application and deliver to City Hall or the Olathe Community Center during operating hours. 

1

Primary Applicant/Head of Household 

 *

Primary Applicant/Head of Household

Last Name	First Name	Street Address
Zip Code	Phone Number ext.	Email
Birth Date (mm/dd/yy)

2

Spouse/Secondary Adult Applicant

Spouse/Secondary Adult Applicant

Last Name

First Name

Birth Date (mm/dd/yy)

3

Including yourself, how many persons make up your household?

 *

Including yourself, how many persons make up your household?

4

Additional Applicants

All additional applicants must be a dependent of the Head of Household (HOH) and must reside in the household. Birth Date is required. 

	Name	Relationship to HOH	Sex (M/F)	Birth Date (mm/dd/yyyy)
Dependent	Additional Applicants All additional applicants must be a dependent of the Head of Household (HOH) and must reside in the household. Birth Date is required.	Additional Applicants All additional applicants must be a dependent of the Head of Household (HOH) and must reside in the household. Birth Date is required.	Additional Applicants All additional applicants must be a dependent of the Head of Household (HOH) and must reside in the household. Birth Date is required.	Additional Applicants All additional applicants must be a dependent of the Head of Household (HOH) and must reside in the household. Birth Date is required.
Dependent	Additional Applicants All additional applicants must be a dependent of the Head of Household (HOH) and must reside in the household. Birth Date is required.	Additional Applicants All additional applicants must be a dependent of the Head of Household (HOH) and must reside in the household. Birth Date is required.	Additional Applicants All additional applicants must be a dependent of the Head of Household (HOH) and must reside in the household. Birth Date is required.	Additional Applicants All additional applicants must be a dependent of the Head of Household (HOH) and must reside in the household. Birth Date is required.
Dependent	Additional Applicants All additional applicants must be a dependent of the Head of Household (HOH) and must reside in the household. Birth Date is required.	Additional Applicants All additional applicants must be a dependent of the Head of Household (HOH) and must reside in the household. Birth Date is required.	Additional Applicants All additional applicants must be a dependent of the Head of Household (HOH) and must reside in the household. Birth Date is required.	Additional Applicants All additional applicants must be a dependent of the Head of Household (HOH) and must reside in the household. Birth Date is required.
Dependent	Additional Applicants All additional applicants must be a dependent of the Head of Household (HOH) and must reside in the household. Birth Date is required.	Additional Applicants All additional applicants must be a dependent of the Head of Household (HOH) and must reside in the household. Birth Date is required.	Additional Applicants All additional applicants must be a dependent of the Head of Household (HOH) and must reside in the household. Birth Date is required.	Additional Applicants All additional applicants must be a dependent of the Head of Household (HOH) and must reside in the household. Birth Date is required.

5

Do you have additional dependents to add? 

 *

Do you have additional dependents to add? (Select an Answer) Yes No

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