Youth Fund Application 2026

    YesNoI am not sure:

    Scholarship for use through December 31Scholarship for use beginning January 1, 2026Both scholarship periodsNot sure - I'd like to speak to a TCHN employee about which scholarship is best for me




    YesNo

    Release of Information Consent
    By submitting this application, I understand that my information may include protected health information. I authorize the release of my information to any person or agency necessary to meet my service needs, including, but not limited to, vendors and partner agencies. This information will be used solely for the purpose of assessing, arranging, and meeting my individual service needs. I release Tri-County Health Network and its partners from any liability related to the sharing of this information.

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