Application

Please Read Carefully

Thank you for applying for a GirlVentures Program. This application only needs to be filled in once during your participation with GirlVentures.

This online application is going to ask a wide range of questions about the participant, the participant’s family, and home.  It is important to answer all questions, as much of our funding is from sources that require us to share statistics about the populations we serve.  Also, the more we know about our applicants and participants, the better our programs can be. All information is 100% confidential.

There are 4 parts to the application.  It will take about 10 minutes to fill in.

1. Part 1 – Participant and Family Information
2. Part 2 – Parent/Guardian Information
3. Part 3 – Additional Household Information and Course Specific Information
4. Part 4 – Application Fees
   

Before applying, please read our policies. Thank you!

>> Step 1 of 4 - Applicant & Family Information

Girl's Name
Last Name
Email
Address
City
State/Province
Zip
Mobile
Home Phone
Birthdate
Grade	5 6 7 8 9 10 11 12 College
Race/Ethnicity	--None-- Asian Pacific Islander Black/African American Hispanic Latina Middle Eastern Native American/Indian White/Caucasian Multiethnic Other
School
Primary Language	--None--Cantonese English French German Spanish Vietnamese Japanese Korean Mandarin Persian Portugese Russian Tagalog Portuguese
Household Income	--None-- 30,000 and below 31,000 - 50,000 51,000 - 75,000 76,000 - 100,000 100,000 and above
Income Type	--None-- Single Double Multi
Do you plan to apply for Financial Aid?	--None-- Yes
How did you Hear About GirlVentures?	--None-- GirlVentures Website Flyer Friend or Family (specify) Healthy School Teams Market Research Organization (specify) Other (specify) Presentation(specify) Board Challenge Newsletter Volunteer Center Website Teacher or school faculty member(specify) Other website (specify) Therapist
Please specify
Parent/Guardian Name