Scholarship Form

ipso facto agricola etc.

Parent/Guardian First Name *

Parent/Guardian Last Name *

Parent-Guardian Email *

Parent-Guardian Email Re-Enter *

Phone #

Girl's First Name *

Street Address (include apt or unit #) *

City *

State/Province *

Postal/Zip Code *

Country

What do you want your girl to have? *

How did you hear about New Moon Girls? *

Can you share why you need support to get NMG?

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