Apply by November 1, 2016. You will receive an email response within 15 business days. Student first name*Student last name*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Phone*Email address we can use to contact you during this application process.*Curriculum license number*If you have lost this number, please email firstname.lastname@example.org with your name and original shipping address.Reasons for AttendingIn a paragraph, please tell us why you would like to attend the 2017 Winter Workshop.* Financial InformationThere is no right or wrong way to answer the questions that follow. These questions just help us understand your situation.Do you live with your parents?*NoYesYes, but only when I am not in schoolDoes anyone claim you as a dependent on their tax forms?*YesNoYour PARENTS' gross taxable income for 2016*Less than $35,000$35,001 to $55,000$55,001 to $75,000$75,001 to $100,000How many dependents do your PARENTS have?*Are you married?*NoYes, and my spouse also wants to come to the Winter Workshop.Yes, but I would be coming on my own.Do YOU have one or more dependents (i.e., children)?*NoYesYOUR gross taxable income for 2016 (if you are married, include your spouse's income in your total)*Less than $35,000$35, 001 to $55,000$55,001 to $75,000$75,001 to $100,000How would receiving a scholarship impact your ability to come? Choose the BEST answer.*I don't know yet if I can afford to come, but receiving a scholarship would definitely help!I plan to come, but receiving a scholarship would make a big difference to my financial situation.Receiving a scholarship is the only way I could possibly come. If I were to receive one, I could definitely come up with the rest of the money.Even if I were to receive a scholarship, I don't know if I will be able to come, but I hope I would.Use this space to share any details about your financial situation you would like us to know about, such as whether you are in school, reasons why you are not able to work as much as you want to, unexpected hardships, etc. But please be brief!* * I understand that submitting this application does not guarantee me a scholarship.