Brainbox Science Student Information and Permissions

Brainbox Science Scholarship Application
Although Brainbox Science is not grant-funded or donation-funded, we’re working toward a world where science exploration is available to everyone. To support that goal, we offer a limited number of partial scholarships for students who could not attend otherwise.

To support the greatest number of people, we can only offer each camper a scholarship for one week of summer camp.

All information requested is confidential and used only to make scholarship decisions.
Family Information
Parent/Guardian completing this form*

First NameLast Name
Relation to child*
Email*
Cell phone*
(###) ###-####
Home Address*
City*
State*
Zip*
Student Name*

First NameLast Name
School*
Current school (or school next fall for summer programs)
Grade*
Use grade next fall for summer programs
Gender*

GirlBoyNonbinaryPrefer not to sayOther
Student's race/ethnicity (optional)
Do you wish to enter information about other students?*

NoYes
Please list the name, school, grade, gender, & race/ethnicity for other students in your care you'd like to have considered for scholarship.
Financial Information
What is your total monthly family income before taxes? Please include all wages, child support & alimony payments, unemployment benefits, foster care payments, public assistance, social security payments, etc.*
How many adults are supported by this income?*
How many children are supported by this income?*
How much can you afford to pay for a week of camp?*
Check any assistance programs from which your student or family receives benefits:

SNAP (Supplemental Nutrition Assistance Program)TANF (Temporary Assistance for Needy Families)Social Security/SSI (Supplemental Security Income)DisabilitySection 8UnemploymentEmployment related day care (ERDC)Other
Is there other information we should consider? (e.g., special circumstances, medical expenses, reasons camp is important for this student)
Signature
To keep the paperwork burden low for families, we hope to operate this scholarship program without requring proof of income. We appreciate your support in keeping a trust-based system possible!

I certify that all information provided is accurate to the best of my knowledge.
Signature*

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Have questions? Please get in touch!

Brainbox Science | support@brainboxscience.com | 971-930-0303
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Brainbox Science Scholarship Application

Family Information

Financial Information

Signature