ClubScientific: Science has never been this much fun!

Use this form to apply for the Shelby Jean Scholarship. Please enter all information requested.
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All applications must be submitted to Club Scientific by May 1, 2008 by using our online form.
All scholarships are subject to availability.
Please answer ALL questions completely.
All applications will receive a response by e-mail.

* Required Items—Please Fill In All Required Items

Camper's Information

* Camper's Name

* Camper's Age

* Grade in the Fall of 2008

* Gender

Female

Male

* Parent/Guardian Name

* Address

* City

* State

* ZipCode

* Daytime Phone xxx-xxx-xxxx

* Evening Phone xxx-xxx-xxxx

* Email Address

Miscellaneous Information

* How many children in the family?

* Ages?

* Camp interested in

* Date?

* Location?

* Is Camper attending more than one camp this summer?

Yes

* If yes, where?

* Dates?

Why the scholarship?

* Briefly explain the circumstance for which you are applying: Please include the name and the date of the parent(s) death. Also include your current extenuating financial situation.

* Why would your child be interested in attending Club Scientific Day Camps?

Electronic Signature

All of the above information submitted is true and complete to the best of my knowledge.

* Parent/Guardian Signature(typed)

* Date

Thank you for your interest in Club Scientific! Science has never been this much fun!

Verification and Comments

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* Required Items—Please Fill In All Required Items

The Shelby Jean Scholarship Application