BoostCamp Application - Summer 2016
Transcripción
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