2024 Techie Camp Student Application (Willow Hill HRC)

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电子邮件地址 *

Student First Name: *

Student Last Name: *

Grade in Fall 2024: *

Gender: *

Select your ethnicity (This information is used for reporting purposes): *

T-shirt Size (Based on adult sizes): *

School Name: *

School District: *

Parent/Guardian Name: *

Parent/Guardian Phone Number: *

Parent/Guardian Email Address: *

City of Residence: *

My family qualifies as Low-Moderate Income (LMI) as defined by government standards (i.e. 80% of HUD income levels for county of residence, Medicaid or free/reduced lunch recipient and/or other guidelines adhering to LMI income parameters). This information will only be used for reporting purposes. *

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