2023 Camp Blodgett STEM Academy Student Application
A parent or legal guardian must complete this form for their child who is currently attending school in 5th, 6th, 7th, or 8th grades and lives in Kent or Ottawa Counties in Michigan.

Please complete the form thoroughly and honestly and to the best of your ability. If a form is needed in Spanish, or other accommodations are needed, please contact Jennifer Grondzik at 616-949-0780 x102 or email jennifer@campblodgett.org
Sign in to Google to save your progress. Learn more
Name of Parent/ Guardian completing this form *
Email address of Parent/ Guardian completing this form *
Phone number of Parent/ Guardian completing this form *
What County does the student live in? PLEASE NOTE: Only students who reside in Kent & Ottawa Counties in Michigan are eligible to apply. *
Full Name of Applicant (First, Middle, Last) *
Applicant's Address: Please provide Street Address, City, State and Zip Code *
Applicant's date of birth *
MM
/
DD
/
YYYY
Applicant's current GRADE in school (2022-2023 school year) *
Does your child qualify for FREE/REDUCED LUNCH at school? *
What is your household's estimated ANNUAL income (current monthly x12 OR actual based on 2022 income) *
What is the number of individuals (children and adults) who live in your household? *
What school does the applicant attend? *
Is the applicant currently (Winter 2023) attending school in-person or other? *
What school will the applicant attend next year (if different than current school)?
Name of applicant's MATH teacher (if only one teacher, name of homeroom/ main teacher) (FIRST & LAST) *
Email address or phone number for applicant's MATH teacher (teacher listed above)
Name of applicant's SCIENCE teacher (if different from above) (FIRST & LAST)
Email address or phone number for applicant's SCIENCE teacher
Why are interested in your child attending STEM Academy? (Check all that apply) *
Required
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms