Texas State Aquarium SeaCamp Scholarship Program Application Survey

Thank you for your interest in the Texas State Aquarium SeaCamp scholarship program. Please complete all fields below. Incomplete applications will not be considered. All applications must be received by March 15, 2013 for priority consideration. A teacher recommendation must also be received by March 15, 2013 for each scholarship applicant. Teachers can access the teacher recommendation form on the SeaCamp page on the Texas State Aquarium website. Limited scholarships are available and notifications of awards will be made by March 31, 2013. ** Applications will continue to be accepted until all funding is awarded.

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1. Name of child:

Name of child:

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2. Age of child:

Age of child:

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3. Male/Female

Male/Female Male

Female

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4. Date of Birth:

Date of Birth:

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5. Grade Entering 2013-2014 School Year

Grade Entering 2013-2014 School Year

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6. Name of parent:

Name of parent:

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7. Address/City/State/Zip:

Address/City/State/Zip: Address:
Address 2:
City/Town:
State:
ZIP:
Email Address:
Phone Number:

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8. Questions for the child to answer:

Questions for the child to answer: What is your school district?
What school do you attend?
What are your hobbies/interests?

9. Why do you want to attend SeaCamp? Please explain in 2-3 sentences.

Why do you want to attend SeaCamp? Please explain in 2-3 sentences.

10. This space provided for additional comments from the child on their desire to attend SeaCamp.

This space provided for additional comments from the child on their desire to attend SeaCamp.

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11. Questions for the parents to answer:

Questions for the parents to answer: Does your child receive reduced fee lunches?
Family household annual income:

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12. Please describe how a scholarship would help your child attend SeaCamp.

Please describe how a scholarship would help your child attend SeaCamp.

13. This space is provided for additional comments from parents.

This space is provided for additional comments from parents.

14. If you are applying for scholarships for other children, please list their names here:

If you are applying for scholarships for other children, please list their names here:

Thank you!