Apply for the Scholarship

Fill out the form below. After applying, you can log in with your first name, last name, and date of birth.

You must be 15 or older to apply.

Student Information

First Name *

Last Name *

Email *

Date of Birth *

Age *

School *

City *

State *

Address

Parent/Advocate Name *

Parent/Advocate Email *

Parent/Advocate Phone *

Which Street Racing Kills (SRK) event, workshop, or presentation did you attend? *

Please include the school, organization, or event name, city, and approximate date.

After applying, log in anytime with your first name, last name, and date of birth.