Student InformationStudent's Name* First Last School* Fall 2022 Grade Level* 9th Grade 10th Grade Date of Birth* MM slash DD slash YYYY Allergies or other Important Medical Information* Primary Contact PersonPrimary Contact Name* First Last Primary Contact Address* Street Address City State / Province / Region ZIP / Postal Code Phone Number*Alternate Phone Number*Email* Secondary Contact PersonSecondary Contact Name* First Last Secondary Contact Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone Number*Alternate Phone Number*Email* PaymentHow would you like to pay?* I want to pay $380 today (via PayPal) I will be paying via check or cash to BTCI I want to register today, but will pay later My student receives free or reduced lunch; scholarship requested $380 Standard Fee* ScholarshipEnter your scholarship justification*Please provide us some information on why you are requesting a scholarship for this student. You can use this field, or attach a file below.Scholarship application letterAccepted file types: doc, docx, pdf, txt, Max. file size: 50 MB.If you would prefer, attach a file that describes the reason for requesting a scholarship for this person. Your letter will be forwarded to Barbara Bielec for review. Registered, but need to pay? If you’re already registered, but just need to pay, please use our general payment form.