Ballin Technology: Scholarship Form

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Please complete this form to be considered for Our Coding Robotics or Engineering class scholarship. If you are requesting a scholarship for multiple kids, please complete a form for each one.

IMPORTANT: Scholarship applications do not guarantee a secured spot to participate in the class. If you are awarded a scholarship you will be notified and your full attendance is required. Failure to attend may make you ineligible for future scholarship awards.

Email *

Parent/Guardian First Name: *

Parent Information: Email Address *

Parent Information: Home phone # or Cell # *

Student First Name: *

Student Last Name: *

Student Age: *

Student Gender: *

Male

Female

Other:

Student Hometown *

City/State

Relationship to student: *

Mother

Father

Guardian(Other)

Teacher/Counselor

Other:

How did you hear about this Ballin Technology event? *

Facebook

Twitter

Community/Partner Organization

Friend/Word of Mouth

Other:

Required

How many Ballin Technology events has the student attended in the past? *

1-2

3-4

Household Income: *

<20,000 per year

20,000- 40,000 per year

40,000-60,000 per year

60,000- 80,000 per year

80,000-100,000 per year

100,000 + per year

Why does your child deserve this scholarship? *

Use the space below to write your answer.

Tell us something about your child? *

Submit

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