Scholarship Application Form

Student's Name*
First Last
Student's Email Address
Gender*
- Male
- Female
Grade Level*
School Name*
Parent's Name*
First Last
Parent's Email Address*
Phone Number*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Annual Household Income (US Dollars)*
Please include total household income including both parents' income.
Which program are you interested in?*
- Summer Math Camp
- College Prep Camp
- Summer Coding Camp
Academic Background / Achievements*