Brush Creek Ranch Science Enrichment Program Application 2017-2018
First Name *
Your answer
Last Name *
Your answer
Preferred first name
Your answer
School *
Current Grade *
Have you ever participated in the Brush Creek Ranch Science Enrichment Program before? *
Sex *
Race / Ethnicity *
Please check all that apply.
Required
Birthdate *
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YYYY
Height *
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Weight *
Your answer
T-Shirt Size *
T-shirts are all ADULT sizes -- please select your answer accordingly.
Please list any allergies and/or any significant medical history. *
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Street Address *
Include unit or apt #
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City *
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State *
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Zip Code *
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Student Email address *
If none, enter "N/A."
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Student Phone Number *
If none, enter "N/A."
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Parent / Guardian First Name *
Your answer
Parent / Guardian Last Name *
Your answer
Parent/Guardian email address *
If none, enter "N/A."
Your answer
Parent/Guardian phone number *
If none, enter "N/A."
Your answer
Do you participate in any other Big Shoulders Fund Programs (e.g., Stock Market Program or mentoring, etc.)? *
If yes, please list the programs below. If no, please enter "N/A."
Your answer
Do you receive a Big Shoulders Fund scholarship (e.g., STEM, Gallagher, White, JCB Family, Access, etc.)? *
If yes, please list the scholarship below. If no, please enter "N/A."
Your answer
Essay 1: Why would you like to participate in the Brush Creek Ranch program? Please discuss something you've learned or experienced related to science that you are most excited about. *
Character Limit: 5000
Your answer
Essay 2: What does being a leader mean to you? Please tell us about a time when you were a leader in your school, at home, or in your community. *
Character Limit: 5000
Your answer
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