Summer Camp Scholarship

Parent/Guardian Name *

First and last name

Email *

Phone *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Student Full Name *

Grade Entering Fall 2025 *

School Attending Fall 2025

Does your child have any allergies or medical conditions? *

Please list any allergies or medical conditions we should be aware of to ensure your child’s safety and well-being during camp

T Shirt Size *

What size T shirt does your student wear?

Which camp weeks can your student attend? *

All camps are 1:00-4:00PM

Why would you like your child to attend the BrainSTEM Summer Camp? *

How would this scholarship benefit your family? *

be Info Does

Consent *

I understand that submitting this application does not guarantee a scholarship.
I give permission for my child’s photo/video to be used for promotional purposes.

Signature *

Clear Signature

Summer Camp Scholarship Application