If you are interested in scholarship program information please complete

form below

Please provide the following contact information, fields in bold are required.
Full Name:
Street Address:
City:
State:
Zip Code:
Home Phone:
Mobile Phone
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How did you hear about us?
Child #1 Information:
Name:
Date of Birth:	- mm/dd/yyyy
Child #2 Information:
Child 2 Name
Date of Birth	- mm/dd/yyyy
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Your privacy is important to us. UIS does not share customer information with any other businesses. E-mail address is used to confirm registration and as a form of communication with our customers.