Summer Camp Scholarship Application Form
Child's Full Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Scholarship Amount Requested
$
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Family Information
Parent 1
Parent Name
First Name
Last Name
Home Phone
Format: (000) 000-0000.
Work Phone
Format: (000) 000-0000.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent 2
Parent Name
First Name
Last Name
Home Phone
Format: (000) 000-0000.
Work Phone
Format: (000) 000-0000.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Other children in family
Configurable list
*
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Additional Information
Child's Gender
Male
Female
Monthly Family Income (Gross)
$
Additional Income
Rows
Income ($)
Welfare AFDC
Child Support
Support from Spouse
Income from 2nd Job
Other
Total Additional Income
Total Monthly Income
Please Explain the Reasons for Need
Submit
Should be Empty: