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*
Primary language spoken in the home*
Total number of children in the household*
Total number of adults in the household*
Financial Information
Does your family qualify for any of the following federal or state-based assistance?*
Please select the income range of your household*
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 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 programOther
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
Participant Information
How many children are you applying to a scholarship for?*
What is your participant(s) ethnicity?
Do your participant(s) attend school in the Summit School District?*

YesNo
Participant 1
1: Participant Name*
1: What grade will they be in fall 2025?*
1: Gender Identity*
1: What program are you applying for?*

Day Camp (For K-5th graders in summer)Pathfinders (For 6th-8th graders in summer)Discovery Camp (For 1st-8th graders in summer)Counselor Assistant Program (For 8th -12th graders in summer)Adventures (For 5th-12th graders in summer)Girls in STEM ( For 4th-8th graders in fall, winter, and spring)Harvest Camp (For K-12th graders in fall)H2O Outdoors (For 9th-12th graders in fall)Other
1: Desired Sessions (exact dates are program dependent):

Session 1: 6/9/25-6/14/25Session 2: 6/16/25-6/21/25Session 3: 6/23/25-6/28/25Session 4: 6/30/25-7/3/25Session 5: 7/7/25-7/12/25Session 6: 7/14/25-7/19/25Session 7: 7/21/25-7/26/25Session 8: 7/28/25-8/2/25Session 9: 8/4/25-8/9/25Session 10: 8/11/25-8/16/25Session 11: 8/18/25-8/22/25
1: Has the participant previously attended KSS programs?*
Participant 2
2: Participant Name
2: What grade will they be in fall 2025?
2: Gender Identity
2: What program are you applying for?

Day Camp (For K-5th graders in summer)Pathfinders (For 6th-8th graders in summer)Discovery Camp (For 1st-8th graders in summer)Counselor Assistant Program (For 8th -12th graders in summer)Adventures (For 5th-12th graders in summer)Girls in STEM ( For 4th-8th graders in fall, winter, and spring)Harvest Camp (For K-12th graders in fall)H2O Outdoors (For 9th-12th graders in fall)Other
2: Desired Sessions (exact dates are program dependent):

Session 1: 6/9/25-6/14/25Session 2: 6/16/25-6/21/25Session 3: 6/23/25-6/28/25Session 4: 6/30/25-7/3/25Session 5: 7/7/25-7/12/25Session 6: 7/14/25-7/19/25Session 7: 7/21/25-7/26/25Session 8: 7/28/25-8/2/25Session 9: 8/4/25-8/9/25Session 10: 8/11/25-8/16/25Session 11: 8/18/25-8/22/25
2: Has the participant previously attended KSS programs?
Participant 3
3: Participant Name
3: What grade will they be in fall 2025?
3: Gender Identity
3: What program are you applying for?

Day Camp (For K-5th graders in summer)Pathfinders (For 6th-8th graders in summer)Discovery Camp (For 1st-8th graders in summer)Counselor Assistant Program (For 8th -12th graders in summer)Adventures (For 5th-12th graders in summer)Girls in STEM ( For 4th-8th graders in fall, winter, and spring)Harvest Camp (For K-12th graders in fall)H2O Outdoors (For 9th-12th graders in fall)Other
3: Desired Sessions (exact dates are program dependent):

Session 1: 6/9/25-6/14/25Session 2: 6/16/25-6/21/25Session 3: 6/23/25-6/28/25Session 4: 6/30/25-7/3/25Session 5: 7/7/25-7/12/25Session 6: 7/14/25-7/19/25Session 7: 7/21/25-7/26/25Session 8: 7/28/25-8/2/25Session 9: 8/4/25-8/9/25Session 10: 8/11/25-8/16/25Session 11: 8/18/25-8/22/25
3: Has the participant previously attended KSS programs?
Participant 4
4: Participant Name
4: What grade will they be in fall 2025?
4: Gender Identity
4: What program are you applying for?

Day Camp (For K-5th graders in summer)Pathfinders (For 6th-8th graders in summer)Discovery Camp (For 1st-8th graders in summer)Counselor Assistant Program (For 8th -12th graders in summer)Adventures (For 5th-12th graders in summer)Girls in STEM ( For 4th-8th graders in fall, winter, and spring)Harvest Camp (For K-12th graders in fall)H2O Outdoors (For 9th-12th graders in fall)Other
4: Desired Sessions (exact dates are program dependent):

Session 1: 6/9/25-6/14/25Session 2: 6/16/25-6/21/25Session 3: 6/23/25-6/28/25Session 4: 6/30/25-7/3/25Session 5: 7/7/25-7/12/25Session 6: 7/14/25-7/19/25Session 7: 7/21/25-7/26/25Session 8: 7/28/25-8/2/25Session 9: 8/4/25-8/9/25Session 10: 8/11/25-8/16/25Session 11: 8/18/25-8/22/25
4: Has the participant previously attended KSS programs?
Participant 5
5: Participant Name
5:What grade will they be in fall 2025?
5:Gender Identity
5: What program are you applying for?

Day Camp (For K-5th graders in summer)Pathfinders (For 6th-8th graders in summer)Discovery Camp (For 1st-8th graders in summer)Counselor Assistant Program (For 8th -12th graders in summer)Adventures (For 5th-12th graders in summer)Girls in STEM ( For 4th-8th graders in fall, winter, and spring)Harvest Camp (For K-12th graders in fall)H2O Outdoors (For 9th-12th graders in fall)Other
5: Desired Sessions (exact dates are program dependent):

Session 1: 6/9/25-6/14/25Session 2: 6/16/25-6/21/25Session 3: 6/23/25-6/28/25Session 4: 6/30/25-7/3/25Session 5: 7/7/25-7/12/25Session 6: 7/14/25-7/19/25Session 7: 7/21/25-7/26/25Session 8: 7/28/25-8/2/25Session 9: 8/4/25-8/9/25Session 10: 8/11/25-8/16/25Session 11: 8/18/25-8/22/25
5: Has the participant previously attended KSS programs?
Please note:
- Some data and information will be included in 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 to assess scholarship eligibility.
- 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

Financial Information

Childcare & Outcomes

Participant Information

Participant 1

Participant 2

Participant 3

Participant 4

Participant 5