Summer Camp Bursary Application 2018 Engineering Science Quest is a not-for-profit organization delivered out of the University of Waterloo. Thanks to the generous contributions of our supporters, we are able to offer bursaries that can subsidize camp fees up to 95%. In order to be eligible for a bursary, please complete the following form in full. All applications will be kept in the strictest confidence, and are destroyed after the summer. Please note the following: There are a limited number of bursaries available. Only those campers demonstrating need will receive a bursary, and even then we may not be able to fill all requests. Please fill out all sections of this form. Only complete applications will be considered. The maximum bursary award is 95% of the camp registration fee. If you do receive a bursary, a thank-you letter from the child or the family will be expected. This will be passed on to the supporters who made our bursary program possible. Your full name is NOT needed on these letters. Only one week of programming per child can be subsidized through this bursary program. At this time do NOT register for a camp. Create an account online at uwaterloo.legendonlineservices.ca, and make a profile for your children as outline in section 3. We have reserved spaces for bursary applicants this year, and you will be able to select them through this package. There are a limited number of spots per week, so it is important that you provide all three ranked choices. Spots will be assigned on a first-come-first-serve basis but we will do our best to accommodate your preferences. Upon awarding of a bursary, We will place you into the camp program and inform you when it s time for you to pay any remaining balance. You will be given instructions as to how to complete your registration and pay any fees owed when you are told about your award. The deadline for application submissions is April 15, 2018. All applications will be reviewed after this date. Completed forms can be faxed or mailed to Engineering Science Quest at: Mail: Fax: 519-885-0533 Scan and email: esqinfo@uwaterloo.ca Engineering Science Quest c/o Engineering Undergraduate Office University of Waterloo, E2-1772 200 University Ave. W. Waterloo, ON N2L 3G1 Please direct any questions to: esqinfo@uwaterloo.ca or 519-888-4856 For more information about Engineering Science Quest, please visit: http://esq.uwaterloo.ca
Section 1: General Information Name: Street Address: City: Province: Postal Code: Primary Phone Number: Email: What is the parent/guardian relation to the University of Waterloo? Check which answer applies: Alumni Grad/undergrad Student Staff Faculty No relation Section 2: Financial Information What is your yearly Family/Household income (please check): Under $20,000 $20,000 - $30,000 $30,000 - $40,000 $40,000 - $50,000 $50,000 - $60,000 $60,000 - $70,000 Over $70,000 Number of people in family/household: Bursary Amount Requested: (Section continued on next page) 1/4
Section 2: Financial Information (Continued) Please indicate why you require financial assistance in the space below (attach another sheet if required): Section 3: Create a Parent Account As part of our bursary placement process, we will enroll successful applicants into our summer camp programs and apply the bursary. After this, we would contact you with enrollment information and ask you to pay any remaining balance on your account. If you already have a parent account in our new registration system, you can skip the following steps. Please login to your account and provide the account numbers for each camper. If you do not have an account with us, first go to https://uwaterloo.legendonlineservices.ca Select sign up and input all required fields. This will create your parent account. Once you have created your account, go to My Account on the left-hand drop-down menu. Select View my Family Group then click on Create Contact. This is where you will input information for each child. Once you have created a child under your family account, they will be listed and automatically assigned an account number. At this time do NOT register for a camp. The account number starts with UW followed by 6 digits. Please provide this information below: Camper Name: Account Number Section 4: Camper Info Name: Grade: (as of Fall 2018) 2/4
Section 5: Select your week I am applying for multiple kids and would like them in the same week: Yes No Please rank your preferred camp & weeks from 1 to 3 in the table below (1 being your first choice, 2 being your second choice, and 3 being your third choice). Week 1 (Jul 3 - Jul 6) Week 2 (Jul 9 - Jul 13) Week 3 (Jul 16-Jul 20) Week 4 (Jul 23 - Jul 27) Week 5 (Jul 30 - Aug 3) Week 6 (Aug 7 - Aug 10) Week 7 (Aug 13 - Aug 17) Week 8 (Aug 20 Aug 24) Banting (Gr 1 & 2) Suzuki (Gr 3 & 4) Newton (Gr 5 & 6) Edison (Gr 7,8 & 9) Hawking (Gr 3 & 4) Payette (Gr 5 & 6) Tesla (Gr 7,8 &9) For off-campus camps: What location is the camp hosted in? 3/4
Section 6: Camper Request Please have the bursary applicant (camper) fill out the following three questions. If needed, feel free to add an extra sheet. If the camper is unable to write, please write their answer for them. Why are you looking forward to attending Engineering Science Quest? What is your favourite thing about school? What is your favourite thing about science, engineering, or technology? Section 7: Parent/Guardian Agreement I, the undersigned parent/guardian hereby declare that all information given is true and complete in every respect; that I have answered all questions on this form and that the bursary is essential to my child s ability to come to camp. Furthermore, I agree that if any circumstances change from those reported on this application I will contact and inform Engineering Science Quest of such changes. Engineering Science Quest reserves the right to rescind any bursaries based on the change of/or discovery of false information. I also agree that my child or I will write a letter of thanks to Engineering Science Quest financial supporters that made this bursary possible. Date: Name (Print): Signature: Office use only: Awarded Amount Reviewer Signature 4/4