Camp Shoreshim Scholarship Application

Camp Shoreshim Scholarship

Application Form
Date Submitted*
Parent Name*

First NameLast Name
Contact Phone Number*
Address*

Street Address

Street Address Line 2

CityState

Zip Code
E-mail*
example@example.com
Child's Name*

First NameLast Name
Birth Date*

MonthDayYear
Child's Name

First NameLast Name
Birth Date

MonthDayYear
Child's Name

First NameLast Name
Birth Date

MonthDayYear
Child's Name

First NameLast Name
Birth Date

MonthDayYear
What type of Camp Scholarship are you applying for?*
Why are you applying for a Camp Scholarship?*
Total # of People in Household
Total Household
# of Adults 18-61
18-61
# of Adults 62+
62+
# of Children Under 5 years
Under 5
# of Children 6-17
6-17
# Employed
Employed
# Homeless
Homeless
# Disabled
Disabled
# Veterans
Veterans
Average Monthly Income*
Income
Monthly Rent/Mortgage *
Signature
Name*

First NameLast Name
Thank you for your submission! All applicants awarded camp scholarships will be contacted by our JFS Intake Coordinator. We look forward to being in touch.
For office use only
Scholarship Approved or Denied

ApprovedDenied
Type of Scholarship
$ Amount of Scholarship Given
Comments
Should be Empty:

Camp Shoreshim Scholarship