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Contact Information

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Last

Phone

Address 1

Address 2

City

State AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY

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Household Information

In order to assist the PWF with fundraising efforts, we need to gather general household information and academic records for all our participants. This information is kept secured and is strictly confidential.

Household Income
$0-$24,999 $25,000-$50,999 $51,000-$74,999 >$75,000'

Do you own, rent or have another housing arrangement?:
Own Rent Other

Total Number of adults (21 yrs and older)

Total Number of minors (20 yrs and younger)

Does your company provide matching funding?:
Yes No Not Sure

Have you graduated from college?:
Yes No

If there is another adult guardian in your household, did he/she graduate from college?:
Yes No Does Not Apply

Academic Release

In order to identify students who could benefit from our educational programs and better suit your child's academic needs we may need to request your child's report card from their school. This information is kept secured and is strictly confidential.

PWF may request my child's report card from his/her school.