Program Application Packet
 2010: June14th -18th, Rising 9th-12th, ICE

 2 - A current grade report from fall 2009
 3 - This page (Program Application Packet - PAP), with a $15 non-refundable application fee (check or money order) for this program only. 
 4 - Optional: Financial Assistance Applicant’s must submit the form included in the PAP and provide requested documentation. 
Attach $15 non-refundable application fee for this program. (Check or money order only - no cash) 

This program requires the applicant to submit by mail the following items: 
 
Student Information
 Student Expectation
 Contract Teacher Recommendation Form in sealed & signed envelope
Student’s Name:                  
1 - A completed General Information Packet (GIP) 
A completed application does not guarantee acceptance to this or any program. 
Application Deadline: Postmarked by April 15th 
Mail all paperwork to:

Felicia N. Auzla - Brewster
ICE Programs
Georgia Tech, CoC
801 Atlantic Drive
Atlanta, GA, 30332-0280

	
	
Financial Assistance Form 	

         Limited financial assistance is available for students who meet financial need requirements and who otherwise would not be able to attend. Requests for financial assistance are based on need and the availability of scholarship support. All financial information will be kept strictly confidential and applying for assistance will in no way affect the evaluation of your child’s application. Please complete the Financial Assistance Form and submit it with supporting documentation with your completed Program Application Packet(PAP). Incomplete applications will not be reviewed. 

Student Information (please type or print) 

Last Name _____________________ First Name __________________________

Eligibility

To be eligible for financial assistance one of the following guidelines must be met:

A.	Student is on the free or reduced lunch program at school. Please provide copy of award letter. 
B.	Student lives in a family with an income of less than $35,000 per year. Please provide a copy of 2009 tax return or W-2 form. 

Financial Assistance Request

I am requesting Financial Assistance for (Program Name)____________________________

We meet____ A ____B (check one) of the guidelines above. 

I am requesting $ __________ towards summer program tuition. 

Parent’s/Guardian’s Signature ___________________ Date _________________ 

      Please attach a copy of the letter from school cafeteria indicating free/reduced lunch status, tax form or other supporting documents. Financial assistance cannot be awarded without supporting documentation.