BACK TO SCHOOL SUPPLIES: APPLICATION


Please complete the following brief application. We will sort out applications by school and then work with the counselors of each school to choose the most qualified candidates. Deadline to submit the application is June 21st, by noon EST. Please visit www.DRMINIYAR.com to find our locations or visit our Facebook page: www.facebook.com/Dr.Raj.Miniyar

Parent’s Name:

Mailing Address:

Cell Number:

E-mail:

Have you applied for any assistance with any other program? If yes, please give details. PLEASE BE TRUTHFUL.

Please describe in details about: 1) Why you are in need of the assistance? 2) How many children you have? Childrens' names and ages. [ Note: THIS IS A VERY IMPORTANT PART OF THIS APPLICATION ]

If you do not get confirmation about the submission of this request, you can also apply in person at our Rome office location.