Escape Application

Your Name *
Your Name
Please send a photo of you and your daughter
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In what state is your permanent residence?
Payment *
What is your total household income? If you are applying for the scholarship, you will need to submit income statements
Are you open to sharing a room with another person? *
I understand *
That this cost includes daily meals, activities, ground transportation, and the services of staff. Flights are NOT reflected in the price or at the responsibility of SheLift
Please include any additional information or personal story you'd like to share.