The Secrets of CSI

							                                       The Secrets of CSI
                                    WSU Spokane CityLab
                          2009 Young Women’s Summer Science Camp
                                    July 13 – July 17, 2009

CAMPER’S NAME:
ADDRESS:
CITY, STATE, ZIP:
PHONE:                                                      GRADE IN FALL?
Email ADDRESS:
T-SHIRT SIZE: (adult sizes) Small ___ Medium ___ Large ___ X-Large ___

Tuition for the 2009 Young Women’s Summer Science Camp is $150, payable at time of registration and due
no later than July 6, 2009. Camp is limited to 20 girls.

                            Make checks payable to Washington State University.

Return this form and payment to:                 Sylvia Oliver
                                                 WSU Spokane CityLab
                                                 P.O. Box 1495
                                                 Spokane WA 99210-1495


                                         Scholarship Application
For campers needing financial assistance, partial scholarships are available based on a sliding-fee scale
determined by family size and annual gross income. This application should be filled out and returned with the
registration for consideration for assistance. Please complete the following to help us determine your need, if
any, for scholarship assistance. All information will be kept confidential and destroyed once registration is
complete.

FAMILY SIZE: (Include all dependents)________________________________________________

FAMILY’S ANNUAL GROSS INCOME: (Include all sources of support, please.)__________________

DOES FAMILY QUALIFY FOR FREE/REDUCED LUNCH RATES?: ______FREE ______REDUCED

ARE THERE OTHER CIRCUMSTANCES THAT AFFECT YOUR ABILITY TO PAY TUITION FEE?: (For example, high
medical bills. Please briefly explain.)
__________________________________________________________________________________________
__________________________________________________________________________________________
_______________________________

AMOUNT FAMILY CAN PROVIDE TOWARD TUITION FEE: $____________
I certify that the information given is correct and verifiable if requested by WSU Spokane and Spokane CityLab
administration, and that inappropriate requests for scholarship assistance will lead to denial of application for
the Young Women’s Summer Science Camp.

__________________________________________               ____________________
Parent or Guardian                                                    Date