Client Scholarship Application Scholarship Application Use this form to request a scholarship. Name* First Last Phone*Email* Organization Providing ScholarshipIncome VerificationComplete this portion if the scholarship you are requesting requires income verification.Household IncomeAttach Current Tax ReturnYou may also submit by email at receptionist@mycounselor.onlineScholarship Agreement FormOnce you submit this application, you will be directed to an agreement form. You must sign and submit the agreement form in order for your scholarship to be processed.