2020 Camp Financial Assistance Application (Full)

Camp Financial Assistance Application
Full Application
Name
First NameLast Name
Male / Female
Address
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
Date of Birth
MonthDayYear
Date
Phone Number
Format: (000) 000-0000.
Email
example@example.com
Last Year Completed in School
Are you attending the Wildlife Camp or the Horse Camp?
What week of camp will you be attending?
To be Completed by Student
If I receive financial assistance and I agree to send a thank you letter to my sponsor before I leave camp. I agree to follow all guidelines and policies set by the Center while I attend camp.
In one paragraph, please state "Why I want to attend camp?
To be Completed by Student
Child's Signature
Clear
To be Completed by Parent / Guardian
Please make a brief statement describing why your child is in need of financial assistance.
To be Completed by Parent / Guardian
What is your occupation / job title?
What is spouse's occupation?
What is the combined/total annual household income: Check the appropriate box.
Rows Under $20,000 $20,000-$30,000 $30,000-$40,000 $40,000 and Up
Income
The amount of assistance is based off a rolling tier.
The items listed below are to be transferred from your 1040: (Includes spouse's information is applicable).
Number of Dependents
Line 6C on 1040, Line 5on 1040 EZ or Line 6C on 1040A.
Adjusted Gross Income
Line 37 on 1040, Line 4 on 1040 EZ or Line 21 on 1040 A.
Total Income
Line 22 on 1040 or Line 15 on 1040 A.
List Special Circumstances (If Any)
Do you have other children attending camp this year?
By signing this document, I agree that the information is accurate.
Parent / Guardian Name
First NameLast Name
Parent / Guardian Signature
Clear
References
To be completed by someone other than a family member. (Ex. Teacher, School Administrator, Scout Leader, Pastor, etc.) Please include a brief statement made by the reference of your choosing, a reference signature, and the relationship to the child. References can be mailed to the our Center.
Please make a brief statement describing why this child deserves a scholarship.
References can be sent using the file upload tabs below or can be mailed to the our Center.
Example Center Financial Assistance Program
123 Camp Road
Anytown, Georgia 11111
Recommendation Letter One:
Cancelof
Recommendation Letter Two:
Cancelof
Please Note: Financial assistance is not guaranteed. It will be determined based on the viability of your application. Assistance will be given based on the availability of funds and level of need.
Please write a descriptive account of why your child is in need of financial assistance.
This application is confidential. The information on the form will not be disseminated.
Our financial assistance committee will meet once a month to allocate funds. the committee will divvy up the Financial Assistance funds received from the Annual Fundraising Banquet until they are diminished.
We will notify applicants of the award amount within 2/4 weeks.
Need is the most important priority for the Financial Assistance Program.
Should be Empty:

Rows	Under $20,000	$20,000-$30,000	$30,000-$40,000	$40,000 and Up
Income

Camp Financial Assistance Application

To be Completed by Student

To be Completed by Parent / Guardian