Scholarship Application
Contact Information
Name:
Street Address:
City, State, ZIP Code:
Home Phone:
Work Phone:
E-Mail Address:
Class Information
Which class would you like to attend?
Class name:____________________________________________
Dates:______________________________
Background
Please tell us if any of the following apply to you:
_____ K-12 Teacher
_____ High School Student
____ Undergraduate Student
_____ Graduate Student
Volunteering
To give back to BUGSS, are you willing and able to volunteer 5-10 hours of time? (This
could include work on a member project or general help around the lab)
____ YES ____ NO
Previous involvement with BUGSS
Summarize your previous experience with the BUGSS organization, including any classes
that you have previously attended.
Future involvement with BUGSS
The BUGSS class scholarship provides a three month BUGSS membership which entitles
you not only to attend courses for free (courses typically run over a 1-2 month period), but
also to use the lab space. If given a scholarship, do you have ideas for how you might use
that additional membership time? Are there projects that you are interested in pursuing at
BUGSS? Please describe below.
Please sign below
Name (printed)
__________________________________________________________________________
Signature
__________________________________________________________________________
Date
__________________________________________________________________________
Our Policy
It is the policy of this organization to provide equal opportunities without regard to race,
color, religion, national origin, gender, sexual preference, age, or disability.
Thank you for completing this application form and for your interest in attending a
BUGSS course!