2022-2023 Program Scholarship Application

Scholarship Application
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Scholarships are designed to enable as many children as possible to have a KSS program experience by providing financial assistance to families with demonstrated financial need.

Please review the KSS Scholarship webpage for more details about the application process and guidelines for receiving a scholarship. If you need assistance filling out the application or have questions you can also contact us at (970)468-2098 or Support@KeystoneScienceSchool.org.
Family Information
Primary Parent/ Guardian Name*

First NameLast Name
Primary Parent/ Guardian Phone Number*
Primary Parent/ Guardian Email*
example@example.com
City of residence*
State of residence*
Does your participant attend school in the Summit School District?*

YesNo
County of residence*
Primary language spoken in the home*
Total number of children in the household*
Total number of adults in the household*
Please list the relationship of adults to the child(ren) being enrolled in the program (mother, father, aunts, uncles, etc.)*
Participant Information
How many children are you applying to a scholarship for?*
School the camper(s) attend

Participant Information*

	Full Name	Grade in Fall 2023	Gender	Ethnicity	Program Applying for	Desired Sessions (If applicable)
Child 1
Child 2
Child 3
Child 4
Child 5

Has the participant(s) previously attended KSS programs?*
If yes, which programs?
Financial Information
Does your family qualify for any of the following federal or state-based assistance? (Check all that apply)*
Please select the income range of your household*
Is this a single income household?*

YesNo
In detail, please explain why financial aid is necessary for your family. Include relevant information about your current employment status and your financial situation. *
Childcare & Outcomes
If my child was not in this program they would have these care options (select all that apply)*
If my child was not in this program they would have these care options (select the most likely option)

At home aloneWith a sibling 10 years old or youngerWith a sibling 11 years old or olderAt work with a parentAt home with an adult family memberWith a baby sitterAt another program
If other, please describe.
What do you and your child hope to gain from this KSS experience?*
Please let us know if there is any additional information you would like us to know about your application
Please note:
- Some data and information will be included within grant reports. Personal identification will not be shared in this process.
- All financial information on this form is confidential and is used exclusively by Keystone Science School and a committee of volunteers for the purpose of assessing scholarship eligibility.
- Please note, that if a child is awarded a scholarship, the recipient will be asked to write about his/her experience so we can share this with our donors. Names will be kept confidential at all times.
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Scholarship Application

Family Information

Participant Information

Financial Information

Childcare & Outcomes