Connelly Foundation Summer Scholars- Intent to Apply Form

1.First Name:(Required.)
2.Last Name:(Required.)
3.Email Address(Required.)
4.Please select your high school from the dropdown box:(Required.)
5.Please select your scholarship type:(Required.)
6.Parent/Guardian Name(s)(Required.)
7.Preferred Parent/Guardian Email(Required.)
8.Select the summer program(s) to which you intend to apply. You may select more than one.(Required.)
9.If applicable, list the program track(s)/course(s) for which you are applying within program indicated above.
10.Provide a brief description of why you are interested in your desired program(s).(Required.)
11.Select below to confirm that you and your family have discussed your intentions to apply, and are in agreement about your selection.(Required.)
12.Please type your name below to indicate your confirmation.(Required.)