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Big Bad Bot Builders – Girl Powered Application
Grades 5 & 6 FEMALES eligible
For the 2022-2023 school year
Date of Birth*
Telephone*Primary Parent Contact InformationPrimary Parent Name*
Relationship*(ie. Mother, Father) Address (If different from above)
Primary Contact Work PhonePrimary Contact Home PhonePrimary Contact Cell PhonePrimary Contact Email*
Other Contact InformationOther Contact Name
Relationship(ie. Mother, Father) Other Contact Address (if different from above)
Other Contact Work PhoneOther Contact Home PhoneOther Contact Cell PhoneOther Contact Email
Additional InformationStudent's Current School* School attending this upcoming 2022-2023 school year?* Grade entering this upcoming 2022-2023 school year?* Please tell us why you would be a good candidate for this program.*Upload Most Recent Report Card*Max. file size: 5 MB.