Black Girls CODE: Scholarship Form
Please complete this form in order to be considered for a scholarship to attend a Black Girls CODE event or workshop. If you are requesting a scholarship for multiple girls, please complete a form for each one.

IMPORTANT: If you are awarded a scholarship and it is claimed, your attendance at the event in question is required. Failure to attend may make you ineligible for future scholarship awards.

Parent/Guardian First Name:
Your answer
Parent/Guardian Last Name:
Your answer
Parent Information: Email Address
A valid email address is required
Your answer
Parent Information: Home phone # or Cell #
Your answer
Student First Name:
Your answer
Student Last Name:
Your answer
Age of participant:
Relationship to student:
For which event would you like to receive a scholarship?
if the event is not on the list, that means we are no longer able to offer scholarships
How did you hear about this Black Girls CODE event?
Required
How many Black Girls CODE events has the student attended in the past?
Household Income:
Use the space below to write one to two sentences explaining why you are applying for a financial need based scholarship:
Your answer
Submit
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