TechREACH: Summer Camps

Application Form

Please fill out the form below to apply for the 2010 TechREACH summer camp, SeaBots: Dive into Science.

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19020 33rd Ave W, Lynnwood, WA, USA
425.977.4741


Student Information
*First Name	*Last Name



*Name of School Student Attends



*Grade of student in Fall 2010:
6th 7th 8th


*Member of TechREACH club during 2009-2010 school year?
Yes No


Custodial Parent/Guardian Information
*First Name	*Last Name



*Home Phone (xxx-xxx-xxxx)	*Work Phone (xxx-xxx-xxxx)	*Cell Phone (xxx-xxx-xxxx)



*Address	*City	*Zip Code (xxxxx)



*E-mail Address



*Will you be applying for a scholarship?
Yes No


If yes: In the event that you do not receive a scholarship, will you still apply for the camp?
Yes No


*Will you need registration materials translated into Spanish?
Yes No




You will receive an e-mail notification that your application has been submitted. We will notify applicants of their admission into the program by May 14th, 2010. Scholarship applicants will receive additional instructions via e-mail.