Free Student Summer Membership Request

NOTE: If you would prefer to fill out a paper form, you can print the form from this link. and email to justice@fundamentalneeds.net or drop off in person at 209 W Main Street, Suite B, Cortez, CO 81321. If you need assistance printing, stop by the Makerspace and ask the front desk to print it for you.

01 - About You

First name

Last name

Birthday

Month

Day

Year

Group or Age Group

Phone

City / Community

School or Organization

02 - Parent or Guardian (Required if Applicant is Under 18)

Parent or Guardian Full Name

Relationship to Applicant

Parent or Guardian Phone

Parent or Guardian Email

03 - Interest & Goals

What draws you to the Makerspace? What would you like to learn or create this summer?

Examples: 3D Printing, laser cutting, textiles, robotics, digital design, entrepreneurship, or something new.

Do you plan to use the Makerspace at least once per week if gifted a membership this summer?

Examples: Yes, as long as I can get a ride to the space or, yes I plan to come on Tuesday afternoons.

How did you hear about this program?

Is there anything else you would like us to know?

04 - Financial Need

In a few sentences, describe why a sponsored membership would help you or your family.

Share whatever feels comfortable. Examples: limited income, recent job change, single-parent household, receiving SNAP or free lunch.

Does your household currently receive any of the following? (Check all that apply - optional)

05 - Consent & Signature

By signing below, I confirm that the information provided in this application is accurate to the best of my knowledge. I understand that sponsored memberships are subject to availability and that Fundamental Needs makes all award decisions. I agree to follow all Makerspace safety rules and membership policies. My personal information will be kept confidential.

Applicant E-Signature

Parent or Guardian E-Signature (if applicant is under 18

Date

Month

Day

Year