School for previous school year (if different from above)
Your answer
Parent/Family Information
Parent/Guardian Name *
Your answer
Student Mailing Address *
Please include city, state, and zip code
Your answer
Parent Mobile Number *
Your answer
Parent Email *
Your answer
Survey Information
Although the survey section is all optional, we strongly encourage applicants to provide the information requested. It helps us to report to our funders to continue to provide free programs.
Parent Occupation
Your answer
Annual Household Income
Choose
Under $10,000
$10,000-$19,999
$20,000-$29,999
$30,000-$39,999
$40,000-$49,999
$50,000-$59,999
$60,000-$69,999
$70,000-$99,999
$100,000-$150,000
over $150,000
Does the student or family own a computer at home?
Choose
Yes
No
If yes, how many?
Choose
1
2
3
4
5
6
7
more than 7
If not, has the student owned a computer at home?
Choose
Yes
No
What is the condition of the home computer(s)?
Choose
Excellent/New
Good
Poor/Old
Does the family have access to internet at home?
Choose
Yes
No
Student Statement
Please answer the following prompt in complete sentences. This section is to be completed by the student only.
Describe your interests in technology, media, and computers. *
Your answer
Describe the role that technology, media, and computers has in your life now. *
Your answer
I verify that I, the student applicant, completed the Student Statement section of this application, and no one else.
Please type your name below as an esignature affirming that the above statement is true.