Pack 65 Financial Assistance Application Form

Scout's Name*

First NameLast Name

Parent's Name*

First NameLast Name

Currently Member of Pack 65?*

YesNo, but want to join with financial aidOther

Scout's Current Den?

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Area CodePhone Number

Email*

example@example.com

For which event/fees are you requesting financial aid? (note: if aid is needed for multiple events, please submit separate form for each event)*

Pack DuesBig TripDay CampWebelos Adventure Camp

For Pack dues, please select the option of financial aid that you are requesting

Payment Plan (divided equally over 6 months)Full amount of fall dues50%Other

For big trip, please select the option of financial aid that you are requesting

Payment Plan (divided equally over 3 months)Full amount of trip50%Other

For day camp, please select the option of financial aid that you are requesting

Payment Plan (divided equally over 3 months)Full amount of camp50%Other

For Webelos adventure camp, please select the option of financial aid that you are requesting

Payment Plan (divided equally over 3 months)Full amount of camp50%Other

For Pack budgeting purposes, do you anticipate needing this aid every year?*

YesNoOther

Please make a brief statement describing why your child is in need of financial assistance. *

To be Completed by Parent / Guardian

What is your occupation / job title? *

If my Scout decides not to attend thee event, to leave the Pack prior to the event or before the end of the Scouting year, I agree we will refund to the Pack any financial aid granted*

YesNo

By signing this document, I agree that the information is accurate.

Parent / Guardian Name*

First NameLast Name

Parent / Guardian Signature*

Please Note: Financial assistance is not guaranteed. It will be determined based on the viability of your application. Assistance will be given based on the availability of funds and level of need. Please write a descriptive account of why your child is in need of financial assistance. This application is confidential. The information on the form will not be disseminated. Our Pack committee will meet once a month to allocate funds. the committee will divvy up the Financial Assistance funds budgeted until they are diminished. We will notify applicants of the award amount within 2/4 weeks. Need is the most important priority for the Financial Assistance Program.

Pack 65 Scoutership/Campership