ELOC × Bedford 2030

Greenlight Awards Program application

Child's Full Name(Required)

First Last

Parent/Guardian Full Name(Required)

First Last

Parent/Guardian Email(Required)

Enter Email Confirm Email

Parent/Guardian Phone

Country Phone Number

Student Email(Required)

Enter Email Confirm Email

Student Phone

Country Phone Number

T-Shirt Size

Home Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Student Headshot Photo

Please upload a photo below.

Max. file size: 128 MB.

Availability & Commitment

Selected students are expected to: ● Attend team meetings biweekly; each month, we will hold one in-person and one virtual team meeting. ● Contribute to their team’s project research, development, and presentation preparation ● Participate in the Bedford 2030 Greenlight Awards showcase in April 2027 (Exact date TBD) ● Communicate promptly with ELOC staff about absences or conflicts

Yes

I have a conflict I would like to discuss

Please describe your conflict below

Parent/Guardian Attestation

● Photo/media release: Please indicate if you giver permission for ELOC and Bedford 2030 to use photos or videos of your child in program materials, social media, and press coverage.

I give permission for ELOC and Bedford to use photos or videos of my child

I do not give permission for ELOC and Bedford to use photos or videos of my child

Signature

By signing below, I confirm that:

● I give permission for my child to participate in the ELOC Bedford 2030 Greenlight Awards program, including virtual meetings and any in-person program activities.

● I understand the attendance and participation expectations described above and will support my child in meeting them.

● I will notify ELOC staff in advance if my child is unable to attend a scheduled session. ● I consent to ELOC contacting me at the phone number/email provided regarding program updates and my child's participation.

ELOC × Bedford 2030

Greenlight Awards Program application

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