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YSA Scholarship Application Form

Applicant information

* Indicates required field

Applicant Name *

First

Last

Age *

Grade level for the 2019/20 school year? *

I identify my gender as: *

School *

Parent/Guardian Name *

First

Last

Relationship to applicant *

Email *

Phone Number *

which scholarship are you applying for? *

Roy Overstreet Scholarship for Minorities Bill & Fran Darrow Scholarship for Girls

if applicable, which underrepresented group are you from? (check all that apply) *

Alaskan Native Native American Black/African American Hispanic Native Hawaiian/Pacific Islander Persons With Disabilities Girl Other

if other, please explain: *

Which of the following programs would you like to be considered (click all that apply): *

Summer Computer Science Workshops for Girls Summer Camps - 1 week After-School Program - 1 month

Short Answer

Please answer the following questions in a few sentences:

How can you contribute to the mission of YSA? *

Which of the four research themes of the Youth CAUSE Initiative do you most identify with? Why? *

Why is diversity important in science or at school? *

what is the biggest issue in wilmington that science can help solve? How can it be solved? *

Submission Approval

Required *

I agree

By selecting the checkbox, I hereby declare that all of the information contained in this application is to the best of my knowledge true and correct. I also allow the Executive Director and Board of Directors of the Young Scientist Academy to review my application in confidence and, if applicable, contact references obtained provided by the applicant, parent and/or guardian. I acknowledge that YSA is an Equal Opportunity Provider and follows all laws of North Carolina.

Signature of Applicant *

Signature of Parent/Guardian *

date *

MM/DD/YYYY

How did you hear about this scholarship? *

Internet School Teacher Social Media Word of Mouth Flyer Other

Submit

Young Scientist Academy // 501(c)(3) EIN 81-4999928
Suite 420, 20 N 4th Street
Wilmington, NC 28401
Ph: (910) 386-1867

Home
DONATE
Code Girls
Programs
About
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