2024 IDEAA Summer Program Application -Draft-

iDEAA Summer Program

| 2024 Application |

Diversity & Innovation Institute

Thank you for your interest in the iDEAA Summer Program 2024!

This program will be held by the Diversity & Innovation Institute (DNOVA) from July 8 - 19, 2024 at the DNOVA Institute Lab located in the Ivy Tech Community College – Lawrence Campus. Participants will also travel to external industry visit locations.

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

Regular Deadline: May 15, 11:59 PM
Education Level

Student's Information:
Full Name*

First NameMiddle NameLast Name
Grade*
Currently in
Birth Date*

MonthDayYear
Phone Number*
E-mail*
Participant's email address. Not a student/school email.
Home Address*

Street Address

Street Address Line 2

CityState / Province

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

Parent / Guardian Information:
Parent/Guardian Name.*

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

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 in STEM fields. 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:*
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 Phone Number*
School Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Counselor Name
Counselor Email
example@example.com
Science/ Math/ Engineering Courses Completed*
GPA*

Tuition and Financial Assistance:
We are excited to announce that all accepted students will be awarded a $400 academic scholarship at their successful completion of the program!
The program fee is $950 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 $950 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 $950 in assistance to offset the cost of the program.

To qualify for financial assistance a family will have to demonstrate economic 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, 3D printing/manufacturing equipment, materials, and some meals. The program fee is collected only if and when the student is accepted into the program. The 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 $950I will pay out-of-state fee of $1,900I 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 full tuition coverage.

Supporting Documents

As a reminder, if you need financial assistance, please upload documents here. If you do not upload documents here, please email a copy to us at contact@dnova.org.
Upload Documents

Browse Files

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*If you have no documents to upload, please continue to the next page.

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?

Less than 200 words.0/200
Do you have any questions or additional comments for us?
Enter the message as it's shown*
Diversity and Innovation Institute

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
Market Research
Designing / Prototyping
Communications
Leadership
Computers / Tablets
Teamwork/Collaboration
Problem Solving
Project Management
Coding / Programming
STEM Careers
Manufacturing Processes
Resume / Interviews

Student's Information:

Parent / Guardian Information:

Emergency Contact Information

Student Demographic Information

School Information

Interests and Goals:

Tuition and Financial Assistance:

Supporting Documents

Signature Conditions