Kivotos Scholarship Application

Student Information

Provide your personal details accurately.

Full Name:

Age:

Gender:

Date of Birth:

Current School:

Current Grade/Year:

Awards / Achievements:

Special Needs (if any):

Provide your current home and mailing information.

Home Address:

Contact Number:

Preferred Campus (if any):

Details of the person responsible for the student.

Parent/Guardian Name:

Relationship to Student:

Guardian Contact Number:

Guardian Email:

Provide someone we can contact in case of emergencies.

Emergency Contact Name:

Relationship to Student:

Emergency Contact Number:

Any other information you think is important.

Siblings (Name and Age):

Additional Notes / Information: