Our Space & Facilities
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
Indicates required field
I identify with gender:
I prefer not to say
date of birth
Best Phone Number
2021 School Year Grade Level
parent/legal guardian name
Relationship to Applicant
Due to the generosity of the Eshelman Foundation and nCino, the Code Girls program is completely
. 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:
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?
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
I agree to receiving marketing and promotional materials
Young Scientist Academy // 501(c)(3) EIN 81-4999928
Suite 420, 20 N 4th Street
Wilmington, NC 28401
Ph: (910) 386-1867
Our Space & Facilities