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All Fields Required Except Three In Red!!

Select Scholarship	Select Damian Shelton Scholarship Daniel Jimenez Scholarship Mike Deluke Scholarship
Today's Date
Parents Full Name
Parents Street Address
City
Zip Code
Email
Phone
Alt Phone (Not Required)
Child's Name
Gender	Select Girl Boy
Child's Age
Special Needs?	Select Yes No
If Yes, Explain (Not Required)
Child's Strength & Health	Select Fair Good Excellent
Additional Comments (Not Required)
	Type The Above Two Words

 

ASI Children's Charities is a 501 (c) (3) non-for-profit organization, incorporated in the state of Texas in 2008.

We are here to serve children and their families in need.