Scholarship - Dr. RJ - Teen Life Coach

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Dr. RJ Life Coaching Scholarship Application

Please complete the application below. Our team will review your details and reach out within 24 hours to discuss your application status.

Parent Name(Required)

First Last

Phone(Required)

Email(Required)

Marital Status(Required)

Married

Single

Divorced

Widowed

Child's Name(Required)

First Last

Child's Age(Required)

Extracurricular Activities

Number of Siblings

Any mental or physical disabilities?

Is your child adopted?

Yes

No

Why are you applying for a scholarship?(Required)

Has a recent event impacted your child?(Required)

For example, divorce, bullying, breakup, etc

What is your family's yearly budget for mental health?(Required)

Yearly Income (Optional)

Employment Status (Optional)

Full-time

Part-time

Unemployed

Retired

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Please note: Scholarships are limited and awarded based on need and availability.

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