BBIT Scholarship Eligibility Form

1

What would you like to do?* This field is required.

Apply for a scholarship

Apply for a payment plan

Apply for a scholarship & payment plan

2

Parent/Guardian Name* This field is required.

First Name

Last Name

3

Parent/Guardian Email* This field is required.

example@example.com

4

Student Name* This field is required.

First Name

Last Name

5

Do You and Your Child(ren) Reside In Cincinnati, OH or Northern KY?* This field is required.

YESNO

6

Do You and Your Child(ren) Reside in One of the Following School Districts?* This field is required.*We are not asking if your child attends one of these school districts, just if you live within one of these districts. Campbell, Kenton, or Boone County Schools Cincinnati Public Schools Dohn Community Schools Lockland Local Mt. Healthy City Northwest Local Norwood Local St Bernard-Elmwood Place City Winton Woods City

YESNO

7

Are You Enrolled In Any of the Following Government Assisted Programs?* This field is required.Child’s Health Insurance Program (CHIP) MedicaidOhio Works First (OWF) Supplemental Nutrition Assistance Program (SNAP) Supplemental Security Income Program (SSI) Temporary Assistance for Needy Families (TANF) Free and Reduced Lunch Program

YESNO

8

Do you have a financial need?

YESNO

9

Please explain your financial need.* This field is required.

10

CONGRATULATIONS!!

You are eligible for the Black Boys in Tech Scholarship.

Your scholarship will be applied to the Summer Camp ONLY. If you would like to apply for a BBIT Scholarship to cover the cost of a premium membership, you will need to apply for the scholarhsip again in the Fall.

-> Please Click Next to Browse Payment Options.

11

PAYMENT PLAN OPTIONS (WITH SCHOLARSHIP)

Your Black Boys in Tech Scholarship has been applied to your Summer Camp Tuition balance. The amount of your payments have been reduced.

Option One - Pay in Full

No.	Due Date	Amount
Payment 1	Due upon reciept	$100

Option Two - 2 payments

No.	Due Date	Amount
Payment 1	May 1st	$50
Payment 2	June 1st	$50

Option Three - 3 payments

No.	Due Date	Amount
Payment 1	May 1st	$50
Payment 2	June 1st	$25
Payment 3	July 1st	$25

Note: Additional fees may be appled for missed or late payments. Please see payment plan agreement for full details.

-> Please Click Next to Select Your Payment Plan

12

Select Your Payment Plan From the Options Below:* This field is required.With Scholarship Applied.

Option One - Pay in Full

Option Two - 2 Payments

Option Three - 3 Payment

13

Sorry, we have bad news :(

Based on the information you provided it is determined that you are not eligible for the BLK Boys in Tech Scholarship.

But don't worry, we've got you covered! If you live in Cincinnati or Northern Kentucky and would still like to participate in a STEM Summer Camp, we would like to offer you one of our premium payment plan options.

If you do not live in Cincinnati or Northern Kentucky, please send us a request to expand to your area at info@blackboysintech.org.

-> Please Click NEXT browse payment plan options, otherwise click the SUBMIT bottom.

14

PAYMENT PLAN OPTIONS

Option One - Pay in Full

No.	Due Date	Amount
Payment 1	Due upon reciept	$200

Option Two - 2 payments

No.	Due Date	Amount
Payment 1	May 1st	$100
Payment 2	June 1st	$100

Option Three - 3 payments

No.	Due Date	Amount
Payment 1	May 1st	$75
Payment 2	June 1st	$75
Payment 3	July 1st	$50

Note: Additional fees may be appled for missed or late payments. Please see payment plan agreement for full details.

-> Please Click Next to Select Your Payment Plan

15

Select Your Payment Plan From the Options Below:* This field is required.

Option One - Pay in full

Option Two - 2 Payments

Option Three - 3 Payment

16

THANK YOU!!

Please submit your application.

You will receive a follow-up email with furture detail regarding your payment arrangement along with a secure secure payment gateway. You can also pay your camp tution on our website at

www.blackboysintech.org/paymentcenter

-> Please Click Submit to Complete Your Application