CHAP Foundation Application

Full Name*


Email Address*


Phone*


Address Line 1*


City*


State*


Zip*


Are you in compliance with the PA Homeschool Law?*
[radio* compliance "Yes" "No"]

How many children are you homeschooling?*


Is at least 1 of your children between 8-17 years old?*
[radio* child-ages "Yes" "No"]

Are you their parent or legal guardian?*
[radio* parent-guardian "Yes" "No"]

How do you plan to use funds? Check all that apply*
CurriculumSchool MaterialHomeschool course or class tuitionSchool Related TechnologyCo-op FeesOther
Briefly explain your financial circumstances, with income and expenses listed.*


Have you received grants or aid from another organization?*


If yes, please list grants or organizations


Any additional comments


I attest that all information is true and agree to use any funds provided as indicated.*
Yes