SCA 2018 Referred Student Registration Form

PROGRAM DATES:

July 9th - 13th, 2018
July 16th - 20th, 2018
August 13th - 17th, 2018

This registration form is reserved for those students who have received a referral. All other students must apply for the program through our main application portal, located at http://www.summercodingacademy.com/apply/. If you have received a referral, you may enroll in the Summer Coding Academy by filling out the information below.

The tuition for a one-week session at SCA is $795 and deadline for SCA registration is June 15th, 11:59 PM EST. Once you have submitted this registration form, please expect an email with further information about the program and the payment process. If you would like to apply for financial aid, please email sca@hsa.net. We hope to see you at SCA this summer!

Participant's Name *

Participant's Name

First Name

Last Name

School *

Grade *

Please select what grade you will be in at the time of the program.

Participant's Email Address *

Participant's Phone Number *

Participant's Phone Number

Country

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Guardian's Email Address *

Guardian's Phone Number *

Guardian's Phone Number

Country

(###)

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Participant's Address *

Participant's Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Please rank your date preferences below. *

Dates are assigned based on availability. Spots fill up quickly so we cannot guarantee that you will receive your first choice. Please choose your first program date option.

Please choose your second program date option.

Do you have any concerns about the listed dates?

Do you have any coding experience? *

Yes

If you checked yes, please briefly describe your experience.

T–Shirt Size *

Please note that these are adult sizes.

Please describe any dietary restrictions. *

Please provide the name of the person who referred you to our program. *