SALSAForm

SALSAForm

Student First Name*

Student Last Name*

Home Address

Address Line 1*

Address Line 2

Zip Code*

Student Gender*

Select

Student Ethnicity*

Select

Date of attendance*

July 14-19, 2024

July 21-26, 2024

Age at attendance*

Select

Applied in past*

Yes

No

Previous Space Camp Scholarship recipient?*

Yes

No

Parent/ Legal Guardian first name*

Parent/ Legal Guardian last name*

parent email*

parent phone*

Phone

Camper school*

school address*

school city*

school zip*

school phone*

Phone

Please tell us what you hope to learn from attending Space Academy*

Please limit your essay to 300 words.

School Verification Form

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