2021 IDEAA Summer Program Application

Parent / Guardian Information:
Under custody of
Parent/Guardian/Emergency Contact names. *
Parent/Guardian/Emergency Contact name. *

First Name Last Name
Parent/Guardian Occupation
Parent/Guardian/ Emergency Phone Number *
Parent/Guardian/Emergancy contact E-mail
Other Parent/Guardian Name(s)
Optional
Other Parent/Guardian Name *

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

Logistics Information:
Special Dietary Needs
Allergies/Medical Needs
T-Shirt Size *
Transportation Arrangement *

Tuition and Financial Assistance:
The program fee is $750 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 200% of Federal Poverty Levels (https://aspe.hhs.gov/poverty-guidelines) 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.
Payment Option *

I will pay the early-bird fee of $600 I will pay the regular fee of $750 I will pay out-of-state fee of $1,500 I 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 $465 assistance to offset the regular program fee.

Supporting Documents and Certification:
Instructions for Uploaded Documents:

As a reminder, if you need financial assistance, please upload documents here. If you do not upload documents here, please mail or drop off a copy of your tax returns or other supporting documents to prove financial hardships to 2060 Shadeland Ave. Suite 110, Indianapolis, IN 46219.
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Health and Science Innovations

2060 N. Shadeland Ave., Suite 110 | Indianapolis, IN 46219

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

www.scienceinnovations.org
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Participant's Information:

Parent / Guardian Information:

References:

Logistics Information:

Interests and Goals:

Tuition and Financial Assistance:

Supporting Documents and Certification: