Mission
After School Program
Workshops
Summer Programming
Birthday Parties
Inspire Girls
Scholarship Application
Creator Camp
Is there anything else you would like us to consider?
Phone Number:
*
Child's Age:
*
Do you receive any of the following?
*
Employment services
Financial Assistance (SNAP)
Home energy assistance (LIHEAP)
Lunch program (free or reduced school lunches)
Commodities
Public Housing
Social Security Disability (SSD)
Supplemental Security (SSI)
Extended foster care
Head Start
Food support
Medical Assistance
Ethnic/racial Background (Requested for State and Federal Reporting)
African/Pacific Islander
African-American
Native American
Hispanic/Mexican-American
White/Nonhispanic
International/Foreign Exchange Student
Other
Income Information - Please check the amount that represents your household's gross monthly income.
*
$0-499
$500-999
$1000 - 1499
$1500 - 1999
$2000 - 2499
$2500 - 2999
$3000 - 3499
$3500 - 3999
More than $4000
Parent / Guardian Name:
*
Total Cost of Activity:
*
Use this form for summer camps or after school programs.
Scholarship requested for:
*
Summer Camp
After School
Both
Which activity(s) are you interested in receiving a scholarship for?
*
Zombie Camp
DaVince Art Camp
Go Wild With Nature Camp
Forensic Camp
Minecraft Camp
Wizards and Warriors Camp
Cinema Camp
Alien Camp
Game Design Camp
After School Program
Other
How many family members are in your household?
*
Child's Name:
*
By entering my name here, I acknowledge that the above specified information is true and accurate.
*
Child's School:
*
Family Contribution:
*
Email:
*
Check here to receive email updates
Child's Grade
*
Thank you for contacting us! If needed, you will hear back within 48-72 hours.
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