2020 Girl Scouts of Greater Atlanta Summer Camp Scholarship Application

2021 Girl Scouts of Greater Atlanta Summer Camp Scholarship Application
Step 1 - Enter Household Information
Name of Parent/Guardian submitting the form *

First Name Last Name
Parent/Guardian Date of Birth *

Month Day Year
Date
Email address of Parent/Guardian *
example@example.com
Cell Phone for Parent/Guardian *

Area Code Phone Number
Work Phone for Parent/Guardian

Area Code Phone Number
Spouse's Name of Parent/Guardian submitting the form (if applicable)

First Name Last Name
Spouse's Date of Birth (if applicable)

Month Day Year
Date
Email address of Spouse
example@example.com
Cell Pone for Spouse

Area Code Phone Number
Work Phone for Spouse

Area Code Phone Number
Address of Parent/Guardian submitting the form *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
County of Residence *
Step 2 - Enter Camper Information (Camper Applicants must have completed the Girl Scout membership enrollment process to apply for a scholarship)
Camper's Name *

First Name Last Name
Camper's Date of Birth *

Month Day Year
Date
Camper's Troop/Juliette # *
Did/Will the camper participate in the 2020 or 2021 Cookie Program *
Did the camper participate in the Fall 2020 Treats and Keeps Program *
Camp Attending (You will need to register through CampInTouch and make a deposit before a scholarship can be approved.) *
Misty Mountain Overnight Dates *
Meriwether Overnight Dates *
Timber Ridge Day Camp Dates *
Misty Mountain Session Name *
Meriwether Session Name *
Timber Ridge Day Camp Session Name *
Amount of Scholarship requested *
What type of Health Insurance does your camper have? *

AmeriCare CareSource PeachState WellCare
Has your camper been to Girl Scouts of Greater Atlanta Camps in the past? *
What camp(s) has your camper attended *

Misty Mountain Overnight Camp Meriwether Overnight Camp Timber Ridge Day Camp Timber Ridge Overnight Camp
How many years has she attended? *
Step 3 - Household Income Verification
# of adults (over 18) living in your household *
# of children (under 18) living in your household *
Marital status of Guardian *
Are you or a family member a veteran or a member of the military *
Do you receive spousal support *
Amount of Spousal Support received monthly *
Do you receive child support? *
Amount of Child Support received monthly *
Do you receive Food Stamps? *
Amount of Food Stamps received monthly *
Do you receive other income? *
Amount and source of other Income *
2020 Household Income *
2021 Expected annual combined household income? *
Is the amount you expect in 2021 significantly different from 2020 (unemployment, reduced hours, COVID-19 impact, divorce, medial reasons, loss of child support, retiring, death of spouse, family size etc.) *
Reason for the change in income. *
What amount can you pay for camp? *
Special circumstances or reason for requesting the scholarship. Give specific details to support your need:
Signature *

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2021 Girl Scouts of Greater Atlanta Summer Camp Scholarship Application