Academic Summer Camp 2026 Scholarship Form

Student Biographical Information

First Name

Preferred Name

Last Name

Birthdate

Why do we collect birthdate?

Gender

Female

Male

Undisclosed

Are you Hispanic or Latino of any race (this includes Spanish and other Spanish origins)?

If not, please check one or more of the following options that you do identify with:

T-Shirt Size

Student Contact Information

Email Address

Mobile Phone Number

Mailing Address

Country

Street

City

Region

Postal Code

Student Academic Information

Expected high school graduation year.

Parent/Guardian Information

First Name

Last Name

Email Address

Mobile Phone Number

Relationship

Summer Camp Details

What is your First Choice camp?

What is your Second Choice camp?

What is your Third Choice camp?

Would you like to attend day camp or overnight?

Would you like to request a specific roommate?

Yes

No

Who is your requested roommate?

To apply for the scholarship, please submit the following:

1. Reference Name: Provide the name and following contact information of a school guidance counselor, pastor, social worker or school administrator who knows you well.

Reference Name

Reference Phone Number

2. Please explain, in 250 words or fewer, how you expect this camp to influence your life.
*Please construct a well-thought-out reply. This essay will be a key factor in determining the scholarship recipients.

Submit

How did you hear about the Academic Summer Camp Program?