Summer Adventures Scholarship - Stuhr Museum : Stuhr Museum

Student Nominee Information:

Name

Student's Name:

First Last

Address*

Student's Address:

Street Address Address Line 2 City State ZIP Code

Contact Phone Number:*

Contact Phone Number:

Student's Age:*

Student's Age:

What Gender Pronoun(s) Does the Student Use:*

What Gender Pronoun(s) Does the Student Use:

Student Race/Ethnicity (Select Multiple Boxes)*

Student Race/Ethnicity (Select Multiple Boxes):

White – For example: German, Irish, English, Italian, Polish, French, etc.
Hispanic, Latino, or Spanish origin – For example: Mexican or Mexican American, Puerto Rican, Cuban, Salvadoran, Dominican, Colombian, etc.
Black or African American – For example: African American, Jamaican, Haitian, Nigerian, Ethiopian, Somalian, etc.
Asian – For Example: Chinese, Filipino, Asian Indian, Vietnamese, Korean, Japanese, etc.
American Indian or Alaska Native – For example: Navajo Nation, Blackfeet Tribe, Mayan, Aztec, Native Village of Barrow Inupiat Traditional Government, Nome Eskimo Community, etc.
Middle Eastern or North African – For Example: Lebanese, Iranian, Egyptian, Syrian, Moroccan, Algerian, etc.
Native Hawaiian or Other Pacific Islander – For example: Native Hawaiian, Samoan, Chamorro, Tongan, Fijian, Marshallese, etc.
Some other race, ethnicity, or origin

What is the primary language spoken at home?*

What is the primary language spoken at home?

What is the highest level of education have the student’s parents completed?*

What is the highest level of education have the student’s parents completed?

Student's Grade:*

Student's Grade:

School Student Attends:*

School Student Attends:

Is the Student on Free or Reduced Lunch?*

Is the Student on Free or Reduced Lunch?

Select options the student would benefit from while participating the the classes:*

Select options the student would benefit from while participating the the classes:

Has Nominee Participated in Summer Adventure Classes Before?*

Has Nominee Participated in Summer Adventure Classes Before?

What Summer Adventures is the student interested in taking? (List Top 3)*

What Summer Adventures is the student interested in taking? (List Top 3)