DPI Precollege Scholarship Application FY23/24

Wisconsin Department of Public Instruction
PRECOLLEGE SCHOLARSHIP APPLICATION
College Applying To
College Address
Professional and Continuing Education
University of Wisconsin-Parkside
900 Wood Road 
Kenosha, WI 53144
Precollege Program Name (Please select, only camps listed below still have scholarships left)
You may receive a maximum of three DPI Precollege Scholarships per year.

STUDENT / PARENT INSTRUCTIONS: Student must be eligible for Free or Reduced Price School Meals, and must have finished fifth grade, but not have graduated from high school to receive a DPI Precollege Scholarship.

Fill out Student Information completely. Parent/guardian must sign in the space provided.

Verification will be required from your school principal or food services authorized representative. Please include school name, school address, and name of school principal or food services authorized individual.
Last Name of Student
First Name of Student
Middle Initial of Student
Address

Street Address

Street Address Line 2

CityState

Zip
Parent Phone Number Area Code/No.
Parent Email
Student Date of Birth Mo./Day/Yr.

MonthDayYear
Date
Student Gender

MaleFemale
Check only one (For Statistical Purposes Only)

Hispanic or LatinoNot Hispanic or Latino
Check all that apply. (For Statistical Purposes Only)

American Indian or Alaska NativeAsianBlack or African-AmericanNative Hawaiian/ Other Pacific IslanderWhite
Current Grade Level

56789101112
Anticipated Year of High School Graduation
School Presently Attending
School District Name
No. of Prior Precollege Scholarships Received This Year
I HEREBY AUTHORIZE release of my child’s verification of Free or Reduced Price School Meals eligibility to the Precollege Campus and DPI.
Signature of Parent/Guardian

Clear
Date Signed Mo./Day/Yr.

MonthDayYear
Date
II.VERIFICATION AND RECOMMENDATION
Instructions to the Principal, Food Services Authorized Representative, or DPI/WEOP Staff Member
Verify that this student is eligible for Free or Reduced Price School Meals and forward this application form to the college or university where the student has applied for admission to a DPI Precollege Program.

YesNo
Is this student eligible for Free or Reduced Price School Meals?

I HAVE VERIFIED that this student is eligible for Free or Reduced Price School Meals and I recommend this student for a DPI Precollege Scholarship.
Name of Authorized Representative
Title
Telephone Area/No.
Verification Signature

Clear
Date Signed Mo./Day/Yr.

MonthDayYear
Date
Should be Empty:

PRECOLLEGE SCHOLARSHIP APPLICATION

Instructions to the Principal, Food Services Authorized Representative, or DPI/WEOP Staff Member