BrainVyne - LEGO® Camp - Scholarship Application

Need based scholarships. Please complete form and upon hearing from us, proceed to registering your child in a camp of your choice. Application deadline is April 15. No Scholarships are awarded for Spring Break Camps, exceptions can be made for certain families. Scholarships will be issued to no more than 2 kids/family. See below.

What is the combined annual income for both parents? Preference is for families with 125K or less per year. If combined annual income is greater than $150,000 please do not apply for the scholarship. You must submit pay stubs to be awarded the scholarship.*

Student First Name*

Student Last Name*

Boy or Girl?*

BoyGirl

Student Date of Birth*

Current Grade*

Name of School*

Parent First Name*

Parent Last Name*

Parent email address*

Parent Phone Number*

Address 1*

Address 2

City*

State*

Zip*

Email Address*

Do both parents work?

Are you applying for more than one child? (skip the next question if you are applying only for 1 child)*

How many children are you applying for?

Enter here complete name, date of birth and grades of sibling you are applying for as well?

How do you think your child/ren will benefit from attending a LEGO® camp?*

What are some of the favorite things your child/ren likes to build with LEGO®?*

Please explain why your child/ren should be the recipient of this scholarship?*

If awarded a scholarship, which weeks would you be interested in?

	Yes	No
6/3 - 6/7
6/10 - 6/14
6/17 - 6/21
6/24 - 6/28
7/1* - 7/5
7/8 - 7/12
7/15 - 7/19
7/22 - 7/26
7/29 - 8/2
8/5 - 8/9
8/12 - 8/16
8/19 - 8/23
8/26 - 8/30
Spring Break