BRF Summer Science Camp Scholarship Application Form
Scholarships are available to campers aged 11-15 who are permanent residents of Orange, Dutchess, and Ulster counties of New York State and qualifies or is currently enrolled in a free/reduced lunch program at their schools (https://otda.ny.gov/workingfamilies/schoollunch.asp)
Child's Full Name
*
First Name
Last Name
Child's Gender
*
Male
Female
Other
Date of Birth
*
-
Month
-
Day
Year
Date
What county does the child reside in?
*
Orange
Dutchess
Ulster
Name of the school the child attends?
*
Grade level
*
for 2021-2022 school year
Does the child qualify for enrollment in their school's free lunch program?
*
Yes, they are currently enrolled in a free lunch program
Yes, they qualify but is not currently enrolled in a free lunch program
No, they do not qualify for free lunch program
Scholarship Amount Requested.
*
Cost of one camp course is $375.
Which camp course is your child interested in taking?
*
The World of Insects: Infinite Variety on a Common Theme, July 12-16
Cold Blooded Creatures: A Course in Field Herpetology, July 19-23
Biodiversity Blitz: From Ambystoma to Zygoptera (art and science), July 26-30
Back
Next
Family Information
Parent 1
Parent Name
*
First Name
Last Name
Email
*
example@example.com
Date of Birth
*
-
Month
-
Day
Year
Date
Home Phone
*
-
Area Code
Phone Number
Work Phone
-
Area Code
Phone Number
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent 2
Parent Name
First Name
Last Name
Home Phone
-
Area Code
Phone Number
Work Phone
-
Area Code
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Other children in family
Configurable list
*
Back
Next
Additional Information
Monthly Family Income (Gross)
$
Additional Income
Income ($)
Welfare AFDC
Child Support
Support from Spouse
Social Security
Income from 2nd Job
Other
Total Additional Income
Total Monthly Income
$
Please Explain the Reasons for Need
*
Submit
Should be Empty: