Name

First Name

Last Name

Birthdate

YYYY

Current School and Grade

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent/Guardian's Name

First Name

Last Name

Parent/Guardian's Email

Parent/Guardian's Number

Will you be able to attend class at least 3x a week?

Household Income

50K Max and proof is required if you're chosen

Submit essay here

Must answer include answers from essay questions. 500 word minimum