2023 Horse Camp Financial Assistance Application (Full Scholarship)

2023 Horse Camp Financial Assistance Application (Full Scholarship)

This scholarship covers full tuition INCLUDING the deposit ($475)
Camper's Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Birthday*

MonthDayYear
Phone Number*

Area CodePhone Number
Email*
example@example.com
Last Year Completed in School*
What week of Horse Camp will your child be attending?*

Week 1: July 2-6, 2023Week 2: July 9-13, 2023
To be Completed by Student
If I receive financial assistance to any camp at the Georgia FFA-FCCLA Center, I agree to send a thank you letter to my sponsor before I leave camp. I also agree to follow all guidelines and policies set by the Georgia FFA-FCCLA Center while I attend camp.
In one paragraph, please state "Why I want to attend camp?*
To be Completed by Student
Child's Signature*

Clear
To be Completed by Parent / Guardian
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? *
What is spouse's occupation? *

What is the combined/total annual household income: Check the appropriate box. *

	Under $20,000	$20,000-$30,000	$30,000-$40,000	$40,000 and Up
Income

The amount of assistance is based off a rolling tier.

The items listed below are to be transferred from your 1040: (Includes spouse's information is applicable).
Number of Dependents*
Line 6C on 1040, Line 5on 1040 EZ or Line 6C on 1040A.
Adjusted Gross Income*
Line 37 on 1040, Line 4 on 1040 EZ or Line 21 on 1040 A.
Total Income*
Line 22 on 1040 or Line 15 on 1040 A.
List Special Circumstances (If Any)
Do you have other children attending camp this year?*

YesNo
By signing this document, I agree that the information is accurate.
Parent / Guardian Name*

First NameLast Name
Parent / Guardian Signature*

Clear
Should be Empty:

To be Completed by Student