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, Guardian or Teacher/Counselor's Name
*
First Name
Last Name
Email
*
example@example.com
Phone
-
Area Code
Phone Number
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
Nonbinary
Monthly Family Income (Gross)
*
Tell us about your child:
*
Tell us about your family situation:
*
Submit
Should be Empty: