Student's Full Name *

Student's Date of Birth *

Student's Address (Street, City, Zip, Country) *

Student's Telephone *

Student's School *

Grade entering in September, 2021 *

Parent/Guardian Contact Name *

Parent/Guardian Phone # *

Parent/Guardian Email Address *

Q1. What about the program calls to you? Why are you interested? (Please offer a headline or two and elaborate.) *

Q2. In what ways can you imagine applying what you learn to your world? (Please offer a headline or two and elaborate.) *

Q3. What is an animal that represents, metaphorically or symbolically, an important aspect of the person you are or want to be? Find any photo of that animal. Take a look at it and explain below the connections you make. The magic is in the connections! (Please offer a headline or two and elaborate.) *

Q4 Which session are you wishing to attend? (Or note a desired future session as we consider adding them.) *

Once admitted and prior to attending my Imagine Corps session, I understand I'll be paying a program fee of $399 for BTT or $699 for ITW (unless adjusted for scholarship), plus follow-up coaching, refinement labs, and concept jam.

Scholarships -- Thanks to the generosity of early supporters, there are a number of scholarships available for families that, especially in this time of difficulty, could not otherwise afford to participate in Imagine Corps. Scholarships are awarded on the basis of demonstrated need, motivation, and potential benefit to the student.