Roseanne Van Norman Scholarship Application

Looking to submit a Scholarship Request? Please complete the form below. You will receive an automated email that your Request has been received and we will be in touch should we need further information. Please note the Request Review process normally takes at least 2-3 weeks. We are working quickly to process all Requests, in a first come, first serve process. Thank you for your patience!

    Child's Name (required)


    Arts and Educational:

    Please Specify:



    Please Specify:

    Tell us Your Story

    Yes! O4K may publish my story!No Thank You
    * By allowing O4K to publish your personal details, you will help inspire other children to realize the opportunities available to them through our sponsorship program. If you choose no, we will be sure to leave out any personal specifics when publicizing a scholarship granted.


    Team/Club Name

    Coach/Teacher Name

    Coach/Teacher Contact Information (email or phone)

    Amount Requested

    Date Needed By

    Please answer the following questions to help us identify your financial status. These questions alone will not solely determine scholarship.

    My household receives Temporary Assistance for Needy Families (TANF).

    My household receives WIC, Cash Assistance or any other state government assistance.

    My household income is less than 150% of the federal poverty level. (Please CLICK HERE for a link to the federal poverty guidelines. Based off of how many in your household, locate guideline amount and multiply by 1.5. Do you fall below this?)

    The child requesting scholarship is Chronically ill? Chronically ill is defined as someone who is not terminally Ill, but has been certified within the previous 12 months by a licensed health care practitioner meeting the following requirements;
    1. Person is unable to perform (without substantial help) at least two activities of daily living for a period of 90 days or more because of a loss of functional capacity.
    2. The person requires substantial supervision to protect himself or herself from threats to health and safety due to severe cognitive impairment.


    The child requesting scholarship is Physically Disabled. This is defined as an individual with a physical impairment that substantially limits one or more major life activities ( examples are seeing, hearing, breathing, communicating, working, walking, etc.)

    Please Upload Proof of Need

    Date of Birth