AtomicMind Foundation Scholar Program Application (Part 1)
Student Name
*
First Name
Last Name
Student Email
*
example@example.com
Parent Name
*
First Name
Last Name
Parent Email
*
example@example.com
Student's Current School
*
Student's Current Grade
*
Please Select
9th
10th
11th
12th
Student's Current GPA
*
Hometown (please include state/province)
*
Ex.: Raleigh, North Carolina
Student Race
*
Please Select
Hispanic or Latino
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White (including Middle Eastern)
Student Gender
*
Please Select
Male
Female
Non-binary
Total Household Income (current year)
*
Please let us know a bit about yourself and your family, and how you feel you would benefit from the mentorship offered to AtomicMind Foundation Scholars on their path toward college admission? [200-350 words]
*
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