BoostCamp Application - Summer 2016

Office Use Only
Date Rec’d ____________
BoostCamp Application - Summer 2016
Student’s Name: _______________________________ Birthdate: _____________________
School: _______________________
Grade Entering Fall 2016:
Please circle your child’s t-shirt size: Youth: S
M
L
XL
__________________
Adult: S
M
L
XL
Parent/Guardian Name: _________________________________________________________
Primary Phone Number: _________________
Email Address: __________________________
Home Address (Including City/Town): ______________________________________________
Are you interested in receiving information about financial assistance* for BoostCamp?
No______
Yes_______
* Access AfterSchool awards partial scholarships based on financial need. An application is not a guarantee of tuition assistance.
Applications must be received by Access AfterSchool no later than
Thursday, May 12, 2016 by:




Online: www.AccessAfterSchool.org/BoostCamp
Email: Save as .pdf and email to: [email protected]
Hand Delivered: Rifle Middle School, 753 Railroad Ave, Rifle
Mail: PO Box 819, Carbondale, CO 81623
Access will notify parents of admitted campers via email by May 19th.
For details about BoostCamp visit AccessAfterSchool.org or call 970.963.4402.
Access AfterSchool • PO Box 819 • Carbondale, CO 81623 • (970) 963-4402 • www.AccessAfterSchool.org
3-31-2016 MLC
Para Uso de Oficina
Date Rec’d ____________
Solicitud para BoostCamp - Verano 2016
Nombre de Estudiante: _________________________ Fecha de Nacimiento: ______________
Escuela: ________________________________
Grado en otoño 2016: ______________
Seleccione el tamaño de camiseta de su hijo: Youth: S
M
L XL Adult: S
M
L
XL
Nombre de padre/guardián: ______________________________________________________
Teléfono: _______________________
Email: ______________________________________
Dirección (incluya ciudad): _______________________________________________________
¿Requiere que Access AfterSchool le provea información referente a ayuda financiera*?
No______
Sí_______
* Access AfterSchool tiene asistencia financiera limitada. No hay garantía que podamos ofrecer ayuda financiera.
Solicitudes deben de ser recibidas no más tarde del jueves 12 de mayo por:



El sitio: www.AccessAfterSchool.org/BoostCamp
Email: [email protected]
En persona: Rifle Middle School, 753 Railroad Ave, Rifle, CO 81650

Correo: PO Box 819, Carbondale, CO 81623
Access notificará a los padres si el joven es admitido por correo electrónico a más
tardar el 19 de mayo. Más detalles: 970-963-4402 o www.AccessAfterSchool.org
For details about BoostCamp visit AccessRF.org or call 970.963.4402.
Access AfterSchool • PO Box 819 • Carbondale, CO 81623 • (970) 963-4402 • www.AccessAfterSchool.org
3-31-2016 MLC