Code Girls Application

2020 Code Girls Application Form

Before completing the Code Girls application form please make sure you have read the information on the Code Girls main page. Applications for the Summer Code Girls program are closed, but please complete the application to be added to the waiting list. The application is straightforward and should take approximately 15-20 minutes to complete. For questions, please email Dr Rob at rob@youngscientistacademy.org.

Applicant Details

* Indicates required field

Student Name *

First

Last

I identify with gender: *

date of birth *

School Name *

Best Phone Number *

Email *

2021 School Year Grade Level *

Address *

Line 1

Line 2

City

State

Zip Code

Country

parent/legal guardian name *

First

Last

Relationship to Applicant *

Program Requirements

Due to the generosity of the Eshelman Foundation and nCino, the Code Girls program is completely free. In addition, all participants will receive lunch each day as well as YSA swag, including a personalized Code Girls t-shirt, identification card and lanyard, and other computer accessories.

Please select your T-shirt size: *

Application Questions

Please provide brief (3-4 sentences) responses to the following questions:

Why do you want to participate in the Code Girls program? *

How can we apply coding for good use in society? *

Tell us something interesting about yourself *

Why is diversity important in science? *

Required *

I agree

I agree and acknowledge that my child’s participation is not the responsibility of the Young Scientist Academy (YSA) or the Harrelson Center, its employees, officers, or agents. I affirm and agree that as parent/legal guardian, I will grant the approved supervisors, educators and chaperones from YSA the responsibility to supervise my child during YSA activities and field trips. I further agree and understand there are inherent risks attendant to these activities – including but not limited to personal injuries that may be sustained while participating in YSA activities. I expressly agree to assume any such risks on my behalf and that of my child. I also grant YSA permission to photograph and video my child, and publish these images on the YSA website and affiliated social media platforms.

signature of Parent/guardian *

Relationship to student *

date *

I agree to receiving marketing and promotional materials

Submit