HU Enrichment - Grant Eligibility Information Request Form

To be eligible you must fit all three categories:

Your age is between 14-18 or 18-24
You reside in one of the following 8 counties (Adams, Cumberland, Dauphin, Franklin, Juniata, Lebanon, Perry or York)
Your student ONLY income is between $0 -$30,268

Please complete the interest form below. Once the form is received, we will be in contact with you about the next steps in the grant process.

Enrollment is first come, first served, based on TANF Application completion date.

Student's First Name

Student's Middle Name

Student's Last Name

Student's Personal Email Address

Student's School Email Address

Student's Phone Number

To be eligible, your age must be between 14-18 or 18-24.

Student's Birthdate

What is your age?

Have you graduated high school or are you still attending?

What high school do you attend?

In what year do you expect to graduate from high school?

To be eligible, you must reside in one of the following 8 counties (Adams, Cumberland, Dauphin, Franklin, Juniata, Lebanon, Perry or York).

What county do you live in?

To be eligible, your student ONLY income must be between $0 -$30,268.

Is your student ONLY income between $0 - $30,268?

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Email Address

Program(s) of Interest

CEEB Code