HBS Program Application

Healthy Brain Scholars Program for Youth
Student Name*

First NameMiddle NameLast Name
Birth Date*

MonthDayYear
Gender*
Student E-mail*
example@example.com
Student Mobile Number*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name of High School*
Current student's grade (School year 2023-2024)*
Have you taken SAT or ACT? If YES, please submit a copy of your score.*
Copy SAT or ACT score

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Please upload an unofficial copy of your current transcript.*

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Please upload a response to the following prompt: 300-500 words. As a student and an individual, reflect on what education means to you. How will a college education impact who you are? How do you plan to use your education in the future?*

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Parent Information Questions
Father's Full Name

First NameLast Name
Mother's Full Name

First NameLast Name
Parent's Email*
example@example.com
Parent's Phone*
Please enter a valid phone number.
What is your father's occupation?
What is your mother's occupation?
Please answer the following household questions
How many college students are in your household currently?*
Number of dependents in your household.*
What is the status of your housing?*
How much is your monthly housing rent or mortgage?*
Please upload the following documents.

1. 2022 Income tax return (Form 1040) 2. W-2 (Year 2022) 3. Schedule C-Profit or Loss from Business or Form 1120 if applicable
Upload 2022 Parent Income Tax Return (Form 1040)

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Upload Parent W-2 (Year 2022)

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Upload Schedule C-Profit or Loss from Business or Form 1120

(If parent owns a business)
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Additional Comments
Please click save if you want to submit the form later.

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Healthy Brain Scholars Program for Youth

Parent Information Questions

Please answer the following household questions

Please upload the following documents.

Please click save if you want to submit the form later.