2020 Camp Financial Assistance Application (Full)

2024 BRCM Program Financial Assistance Application

Full Application
Parent/Guardian

First NameLast Name
Number of children in your household attending program*

123 or more
Child 1 *

First NameLast Name
Program Attending*

Little GROWers Summer CampJunior GROWers Summer CampMuseum Without Walls ProgramOther
Child 2

First NameLast Name
Program Attending

Little GROWers Summer CampJunior GROWers Summer CampMuseum Without Walls ProgramOther
Child 3

First NameLast Name
Program Attending

Little GROWers Summer CampJunior GROWers Summer CampMuseum Without Walls ProgramOther
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Email*
example@example.com
In one paragraph, please state "Why I want my child(ren) to attend this program?*
To be Completed by Student
Please make a brief statement describing why your family is in need of financial assistance. *
To be Completed by Parent / Guardian
How much financial aid are you requesting?*
*We cannot guarantee your full request
What is your occupation / job title? *
What is spouse's occupation? (n/a if not applicable)*

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

First NameLast Name
Parent / Guardian Signature*

Clear
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. We will notify applicants of the award amount within 2 weeks. Need is the most important priority for the Financial Assistance Program.
Should be Empty:

2024 BRCM Program Financial Assistance Application