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Chacruna Events - Scholarship Application
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* Indicates required question
Email
*
Your email
First Name
*
Your answer
Last Name
*
Your answer
Phone Number
*
Your answer
City, State
*
Your answer
Birthdate
*
MM
/
DD
/
YYYY
Gender
*
Your answer
Ethnicity
*
Asian
Black/African American
Hispanic/Latinx
Native American
Pacific Islander
SWANA
White/Caucasian
Additional Identity (fill in below)
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Additional Identity
Your answer
Affiliation / Profession
*
Your answer
Are you a student?
*
Yes
No
Name of school/program?
Your answer
Which event are you requesting a scholarship for?
*
Your answer
What scholarship percentage would you need to be able to attend this event?
*
30% off
50% off
100% off
Other:
Please write a brief statement (250 words max) describing your interest in attending the event and why you should receive a scholarship ticket.
*
Your answer
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