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
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