BLBC Scholarship Application

1
Who is completing this form?* This field is required.
First Name
Last Name
2
Email* This field is required.
example@example.com
3
Phone Number* This field is required.
Area Code
Phone Number
4
Relationship to child(ren)- If the form is for you type your name* This field is required.
5
Name(s) of Child(ren)
1st Child's name
2nd Child's name
3rd Child's name
6
To process a scholarship request, we must receive a registration and deposit. Have you submitted a registration form and deposit on our website?
YESNO
7
Are you requesting a scholarship for Day Camp or overnight camp?
Day Camp (1st-6th grade)
Day Camp (7th-9th grade)
Winter/Summer Camp
Men's/Women's Retreat
Other
8
Let us know which week of Day Camp you're requesting a scholarship for.
Day Camp 1
Day Camp 2
Day Camp 3
Day Camp 4
Day Camp 5
Day Camp 6
Day Camp 7
Day Camp 8
Day Camp 9
Day Camp 10
Other
9
Select which camp you anticipate you or your child(ren) will be attending.* This field is required.
Junior 1
Junior 2
Junior 3
Middle School
High School
All-Star (6th-8th Grade)
WinterPalooza (3rd-5th Grade)
Women's Retreat
Men's Retreat
Family Camp
10
Why do you want to send your child to camp? If this is for a retreat specify why you would like to attend the retreat* This field is required.
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11
Estimated Annual Family Household Income (before taxes)* This field is required.
under $8,000
$8,001-$12,000
$12,001-$18,000
$18,001-$25,000
$25,001-$35,000
$35,001-$45,000
$45,001-$60,000
$60,001-$75,000
Over $75,000
12
If Estimated Annual Family Household Income is over $75,000, please specify amount:* This field is required.
13
Household Information* This field is required.
Number of adults in household
Number of children in household
Monthly housing expenses
Monthly childcare expenses
All other monthly expenses
14
What percentage of your registration cost are you requesting a scholarship for?
20%
35%
50%
15
Provide us with information as to why you are requesting a scholarship. * This field is required.Occupation, employment status/history, extenuating circumstances, other things you are not doing because of finances, etc.
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16
How have you and/or the camper have made efforts to save or earn money for camp?* This field is required.
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17
List any help you may be receiving from others * This field is required.(church, extended family, friends, etc.) (Receiving help from others will NOT decrease the amount available from camp.)
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18
Please include a message from the camper(s) and/or one from yourself that we can pass along to the scholarship fund donors. (We will pass along messages anonymously, but may include camper age and camp type.)
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19
Did you receive a Black Lake Bible Camp scholarship last year?* This field is required.
YESNO
20
"I attest that the information given in this scholarship request is true and accurately reflects my financial and household situation. I will contact the camp registrar to update my application if any of the information changes."* This field is required.
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