Student Scholarship Application
and Teacher Recommendation Form
Core Element believes that every student should have the opportunity to explore their interests and discover their talents
as they relate to Science, Technology, Engineering and Math (STEM). Our organization proudly offers financial scholarships
ranging from minor reductions to full scholarships based on donations and sponsorships received. Recipients are selected
based on financial need and interest in STEM learning. Applicants requesting scholarships greater than 25% may be
required to meet with members of Core Element in order to be considered for the scholarship. Teacher recommendation
may be attached to this form or mailed directly to the Program Director. Please complete information below and return to
Core Element’s Executive Director. (Jan Brenan, Core Element, PO Box 6123, Metairie, LA 70009)
MUST BE POSTMARKED BY MAY 16, 2015
Camp Session: Robotics Camp: July 20-24, 2015______ Arduino Camp: July 27-31, 2015_______
STUDENT INFORMATION
STUDENT NAME:
DOB:
AGE:
SCHOOL ATTENDING IN FALL:
GRADE:
PARENT/GUARDIAN NAME:
CELL/HOME PHONE:
(
)
PARENT/GUARDIAN NAME:
WORK PHONE:
( )
CELL/HOME PHONE:
(
)
EMAIL ADDRESS:
EMAIL ADDRESS:
ADDRESS:
ADDRESS:
CITY:
GENDER:
Male Female
STATE:
ZIPCODE:
CITY:
WORK PHONE:
( )
STATE:
ZIPCODE:
PARENT QUESTION
Is your child currently eligible to receive free or reduced lunch at
Free
Reduced
school?
No, we do not qualify for F/R lunch
If you answered no, please briefly describe the financial circumstance(s) that support your request for a reduced program
scholarship.
Please indicate the dollar amount of the fee waiver that is being requested and that would make it possible
$
for your child to participate in our Summer STEM Camp.
Parent/Guardian: Please have your child write their response below. Attach separate form if they need more room.
Describe why you are interested in participating in the Core Element Summer STEM Camp and what you find most
interesting about science, technology, engineering, math or robots in general.
STUDENT QUESTION
I certify that the information provided above is accurate to the best of my knowledge. I acknowledge that the awarding
of a financial scholarship is solely at the discretion of Core Element.
Parent/Guardian Signature:
Date:
Student Scholarship Application
and Teacher Recommendation Form
For scholarship consideration, please have teacher complete the information below and either return to student or mail to:
(Jan Brenan, Executive Director Core Element, PO Box 6123, Metairie, LA 70009). If you have any questions, please contact
us at admin@core4kids.org or 504-274-3611.
TEACHER: Core Element believes that every student should have the opportunity to explore their interests and discover
their talents as they relate to Science, Technology, Engineering and Math (STEM). Our organization proudly offers financial
scholarships ranging from minor reductions to full scholarships. Scholarship award is based on financial need and an
interest in STEM learning. Please complete this letter of recommendation, seal it in an envelope and return to student or
address listed above.
MUST BE POSTMARKED BY MAY 16, 2015 (please return to parent as soon as possible)
Camp Session: Robotics Camp: July 20-24, 2015______ Arduino Camp: July 27-31, 2015_______
STUDENT INFORMATION
STUDENT NAME:
GENDER:
Male Female
SCHOOL ATTENDING IN FALL:
GRADE:
PARENT/GUARDIAN NAME:
PARENT/GUARDIAN NAME:
TEACHER’S NAME:
EMAIL ADDRESS:
SUBJECT:
PHONE:
TEACHER RECOMMENDATION
Please describe the student’s demonstrated interest in science, technology, engineering or math. Feel free to list any other
important circumstances that would be favorable in deciding on scholarship eligibility.
Teacher’s Signature:
Date: