Girls Code Club 2016-2017 ScholarshipApplication

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Thank you for your interestinscholarships for the Lancaster Science Factory 2016-2017Girls Code Club program. There arefive need-based scholarships availablefor this program, which involves 9 monthly meet-ups between September and May, with a capstone week of summer code camp to those attending at least 7 meet-ups. If you are approved, you must submit a Girls Code Club registration form.

Deadlines:You must complete and submit this application no later than Friday, September 9. The first Code Club meet-up is on Saturday, September 17. Please review our programdescription and availability online ( or call the office (717-509-6363 x105) to find out if there are still spaces available.

Child’s Name: ______Grade last completed: _____Application Date: ______

Street: ______City: ______State: ______Zip: ______

Primary Contact Name: ______Phone Number: ______Email: ______

Annual Household Income:Family Size:

_____ Zero - $10,000_____ $30,001 – $40,000_____ 2-3

_____ $10,001 - $20,000_____ $40,001 - $50,000_____ 4-6

_____ $20,001 - $30,000_____ Over $50,000_____ 6 or more

 I hereby apply for Lancaster Science Factory Girls Code Club financial assistance for the child listed above. I certify that I am financially unable to pay the regular fee.

 I hereby certify that every attempt will be made for the child to attend all meet-up sessions. I understand that only girls attending at least 7 of 9 meet-ups qualify for a summer camp scholarship.

Parent or Guardian Signature ______Date ______

Parent or Guardian (please print name) ______

Please hand-deliver, mail, fax, or scan/email this form to:

Lancaster Science Factory,Attention:Rachel Cahill

454 New Holland Avenue

Lancaster, PA17602

Telephone: 717-509-6363 x105 Fax: 717-509-6386 Email:

Spaces for scholarship club members cannot be reserved without completion of both sides of this form. If scholarship is awarded and the child is a ‘no-call, no-show’, that child will not be eligible for scholarships in the future.

Scholarships are awarded based on date received.

Girls Code Club scholarships are provided to families with financial need through generous grants from the Kalas Sylvin Foundation, QVC Foundation, Dart Foundation, First Nonprofit Foundation, and Junior League of Lancaster.

Required Recommendation and Applicant Essays- Page 2 of 2

Please address any known financial need (student qualifies for reduced lunch, single-parent family, multiple siblings, etc).

Part 1: Teacher or Other Professional Recommendation:

Name: ______Job Title: ______Date ______

School Name: ______

Phone: ______Email: ______

Reason for recommending this child for Girls Code Club (attach additional pages if needed):

Recommender Signature: ______

Part 2: Written request (by child) for attending Girls Code Club (attach additional pages if needed):

Child or Parent Signature: ______