Revival Productions Camp Scholarship Application
2022 Summer Camps
Thank you for your interest in applying for an income-driven tuition scholarship!
Scholarships are provided on a first come, first serve basis. You will be asked to provide your most recent Form 1040 (2020 or 2021), two most recent pay stubs, and a photo ID. NOTE: All sensitive information is thoroughly secured. Yours and your child(ren)'s safety is of the utmost importance to us. If you have questions, please contact heathergrayberg@revival-productions.com or call 610-455-4300. Upon submission, you will receive an e-mail with 48 hrs. about next steps. It has been affordably priced to accommodate as many people as possible. It is still eligible for the 10% multi-camp discount.
PARENT/GUARDIAN
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
example@example.com
Phone Number
-
Area Code
Phone Number
Name(s) of Participants and Ages (separated by comma, as such) i.e. Joe Smith (7), Judy Smith (9)
In which municipality do participant(s) reside?
Which ethnicities/race(s) do participants identify as? (This information does not change the outcome of scholarship. It is simply for grant reporting and to ensure that as an organization, we are fulfilling our dedication to diversity)-please check all that apply
American Indian/Alaska Native
Black or African American
Hispanic or Latino
Native Hawaiian or Pacific Islander
Asian
White/Caucasian
Prefer Not to Answer
Other
Please submit your most recent FORM 1040 (2020 or 2021)
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Please submit two most recent pay stubs (can be photos/scanned images)
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Please submit a photo ID
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Agreement
All information provided is in the effort to obtain an income-driven tuition scholarship. Upon contact from a Revival Productions representative and confirmation of impending payments/personal coupon code, the deposit or full amount in accordance with the registration platform will be due with formal registration within 7 days of e-mail response/coupon code receipt. After 7 days, the scholarship opportunity may be passed on to the next eligible participant, as this is a "first come, first serve" limited program. Filling out this form does not automatically grant you a scholarship, but provides necessary information toward the next step. All payments are non-refundable. By e-signing, you agree to all of the above conditions and certify that all information provided is accurate to the best of your knowledge.
Signature
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