2024 Young Innovators Quest Application -Draft-

Young Innovators Quest

| 2024 Application |

Diversity & Innovation Institute
Thank you for your interest in the The Young Innovators Quest (YiQ) summer program! It is hosted by Diversity & Innovation (DNOVA) Institute from June 3-22, 2024 at IU Indianapolis and other locations in Indiana.

Please complete this form to apply.

If you need to pause or take a break, you can click the "Save" button at the bottom of this form. Copy the link provided and paste it somewhere safe on your computer. When you are ready to continue, simply follow the link back here.

DNOVA staff will review applications following the regular deadline, with notifications sent soon thereafter.

Please check your email for communications after submitting the application

Extended deadline:
May 15, 2024 11:59 PM EST
Education Level

Student Information:
Full Name*

First NameMiddle NameLast Name
Birth Date*

MonthDayYear
Grade*
Currently in
E-mail*
Participant's email address. Avoid using school email address.
Phone Number*
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Transportation Arrangement*
T-Shirt Size*
Allergies
Special Dietary Needs
Under custody of*

Parent / Guardian Information:
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Occupation*
Parent/ Guardian Phone Number*
Parent/Guardian E-mail*
Other Parent Name(s)
Optional
Other Parent/Guardian Name(s)

First NameLast Name
Other Parent/Guardian Occupation
Other Parent/Guardian Phone Number
Other Parent/Guardian E-mail
Emergency Contact Information
Emergency Contact Name*

First NameLast Name
Emergency Contact Phone Number*

Area CodePhone Number
Emergency Contact Email*
example@example.com

Student Demographic Information:

DNOVA values diversity. To that end, we seek to ensure diversity in our programs. Collecting demographic data from our participants helps us evaluate our success in this objective.
Gender*
My ethnic background is best described as (choose all that apply):*
I identify my race as (choose all that apply):

AsianBlackNative American or Alaska NativePacific Islander or Native HawaiianWhiteOther
Do you participate in a "Free or Reduced Meal" Program?*

YesNo

School Information:
School Name*
School Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
School Phone Number*
School Counselor
Science/ Math/ Engineering Courses Completed*
GPA*
GPA Point System*
Is GPA Weighted?

Tuition and Financial Assistance:
We are excited to announce that all accepted students will be awarded a $600 academic scholarship at their successful completion of the program!
The program fee is $1,450 per student. This amount represents about 40% of the total cost per student, with the remaining 60% covered by grants and donations.

As a college student, you automatically qualify for financial aid, which covers the full tuition amount. To ensure your tuition coverage, simply select the box indicating your intention to apply for full tuition coverage during the application process.

Upon acceptance into the program, you will receive confirmation of your acceptance along with confirmation of your tuition coverage. Please note that the program fee includes workshops, industry visits, access to laboratory equipment, materials, transportation, and some meals.

All applicants must pay a registration fee of $10 once accepted. If financial assistance is applicable, it will not cover your registration fee.

Should you have any questions or require further assistance, please do not hesitate to contact us at contact@dnova.org.
Payment Option*
The program fee is $1,450 per student. This amount represents about 40% of the total cost per student, the other 60% of the cost is covered by grants and donations. From these grants and donations we have created a fund to offset the cost of the program fee for families that cannot afford to pay the full amount. The level of financial assistance will depend on available funding and level of need. Each student may request up to $1,450 in assistance to offset the cost of the program.

To qualify for financial assistance a family will have to demonstrate financial hardship by providing evidence (e.g. student's participation in free and reduced meals at school, federal income tax returns, any document showing recurring expenses like mortgage, rent, student debt, etc.). We will consider financial assistance for families with a gross income below 300% of Federal Poverty Levels and/or students who are currently participating in Free and Reduced Meals programs.

Program fee includes workshops, industry visits, use of laboratory equipment, materials, transportation, and some meals. The program fee is collected only if and when the student is accepted into the program. Program fee is non-refundable after the program starts.

All applicants must pay a registration fee of $10 once accepted. If financial assistance is applicable, it will not cover your registration fee.

*If you would like to apply for financial assistance, please email your family's tax return information from the previous year to contact@dnova.org.
Were you referred to this program by one of the following?

DNOVA AmbassadorDNOVA DonorNot Applicable
Please provide the full name and email of referee(s).*
Discount Code
Payment Option*

I will pay the regular fee of $1,450I will pay out-of-state fee of $2,900I would like to request financial assistance
Answer the following questions if you are requesting financial assistance:
Number of Persons in Family / Household
Household Gross Income
From your Federal Tex Return or W2 forms
Household Net Income
Gross income minus recurring living expenses (including any student debt, child support, alimony, rent, mortgage, utilities)
Tuition Assistance Request
You may request up to $1,500 assistance to offset the regular program fee.

OPTIONAL: Supporting Documents

To aid your application, feel free to attach a PDF (or JPEG) copy of your high school transcript and/or a recommendation letter from a teacher here. If you would like to provide these documents, but do not have them ready now, you can also email them to us at contact@dnova.org.
Teacher Recommendation Letter PDF

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School Transcript PDF

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Signature Conditions

By signing below, I attest that all information included in this application is complete and correct.
Signature

Clear
How did you hear about this program?*
Do you or your parents have any questions or additional comments for us?

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Do you have any questions or additional comments for us?

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Enter the message as it's shown*
Diversity & Innovation Institute, Inc.

9100 Purdue Rd., Suite 410 | Indianapolis, IN 46268

Ph: (317) 703-7836 | contact@dnova.org

www.dnova.org

Should be Empty:

	Not Interested	Indifferent	Interested
Creativity
Innovation
Intellectual Property
Scientific Research
Designing / Prototyping
Communications
Leadership
Technology
Teamwork/Collaboration
Problem Solving
Project Management
Coding / Programming
STEM Careers
College Life
Resume / Interviews
Medicine/Health
Social Sciences/Psychology

Student Information:

Parent / Guardian Information:

Emergency Contact Information

Student Demographic Information:

School Information:

Interests and Goals:

Tuition and Financial Assistance:

OPTIONAL: Supporting Documents

Signature Conditions