STEPS Application Form 2013

STEPS

STEPS Application Form 2013

Please note: This application is only for girls entering 7th grade who wish to participate in the STEPS for Girls summer program.

*We are still accepting applications for the 2013 program, but space is limited. Please apply now to secure your spot.

Camper Information

First Name:

Last Name:

Middle Initial:

Camper Email:

Birth Date:

mm/dd/yy

School Information

School Name:

School City:

School State:

Parent or Guardian Contact Information

Parent/Guardian:

Street Address 1:

Street Address 2:

City:

State:

Zip:

Home Phone:

(555-555-5555)

Work Phone:

Cell Phone:

Parent Email 1:

Parent Email 2:

Scholarships

Limited full scholarships are available to free or reduced lunch applicants.

I qualify for free or reduced lunch:

Yes

If "No" for free or reduced lunch, please skip to the next section.

To be considered for a scholarship, please write a brief essay (150 words or less) explaining why you want to attend STEPS and what you hope to learn. Scholarship recipients will be notified by April 1.

Short Essay:

If a scholarship is not available, select one:

I would like to be placed on a waiting list for a scholarship

I am willing/able to pay full tuition to attend the camp

Ethnic Background (optional)

Ethnicity:

Black (African American not of Hispanic origin)

Asian or Pacific Islander

American Indian or Alaskan Native

Hispanic

White (not of Hispanic origin)

Camp Preference

Please indicate a preference for each week (1 = most preferred, 4 = least preferred). If your most preferred week is full, you will be assigned your next preference. If all weeks are full, you will be added to the waiting list.

July 7-11, 2013:

July 14-18, 2013:

July 21-25, 2013:

July 28-Aug 1, 2013:

How did you hear about STEPS?

Please select one:

If other, please specify:

Please click the submit button only once.
It may take a moment to send your application. Thanks!