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I'm New
I'm New
Staff
Elders
Elders
Ministries
Kids
Youth
The Salt Company
Adults
Connection Groups
Classes
Care
Sending
Connect
Events
Serve
Baptism
Membership
Messages
Resources
Give
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YTH Financial Assistance Form
Error
Form Entry
Veritas Students Financial Assistance Form
Campus
Cedar Rapids
Urbana
Campus is required.
First Name
First Name cannot contain special characters such as quotes, parentheses, etc.
First Name cannot contain emojis or special fonts.
First Name is required.
Last Name
Last Name cannot contain special characters such as quotes, parentheses, etc.
Last Name cannot contain emojis or special fonts.
Last Name is required.
Mobile Phone
Mobile Phone is required.
Gender
Male
Female
Address
AL
AK
AS
AZ
AR
CA
CO
CT
DE
DC
FM
FL
GA
GU
HI
ID
IL
IN
IA
KS
KY
LA
ME
MH
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
MP
OH
OK
OR
PW
PA
PR
RI
SC
SD
TN
TX
UT
VT
VI
VA
WA
WV
WI
WY
Student's First Name
Student's First Name is required.
Student's Last Name
Student's Last Name is required.
Email Address
Email address is not valid
Email Address is required.
Phone Number
Phone Number is required.
What is the student's current grade?
6th
7th
8th
9th
10th
11th
12th
What is the student's current grade? is required.
Parent's Name
Parent's Email
Please give a brief description for why you are requesting financial assistance.
Please give a brief description for why you are requesting financial assistance. is required.
What type of assistance are you requesting?
Scholarship
Payment Plan
Payment Plan and Scholarship
What type of assistance are you requesting? is required.
If you are requesting a payment plan, please outline a proposed structure of a plan that will be feasible for you. If only requesting a scholarship, skip this question.
How much can you commit to paying for this event?
$
How much can you commit to paying for this event? is required.
Submit