Application Form

2002 Summer Enrichment for Grades 4-12
University of Pittsburgh at Titusville


Name:  
Grade:  
School:  
Home Address: _____________________________________________________
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Indicate the camp(s) that you apply for:
    Day Camp I   (July 15 - 19)
    Day Camp II  (July 15 - 19)

  Overnight Camp (July 8,9,10)
For Scholarship Application Only
G.P.A.: ___________________________________
Family Income and Size: ___________________________________
Parent/Guardian's Name and Signature:

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We reserve the right to cancel the camp if the minimum number of students is not obtained.