Youth Scholarship Application Form
Child's Full Name
*
First Name
Last Name
Desired Camp/Class and Date
*
Camp/Class
Date
Date of Birth
-
Month
-
Day
Year
Date
Scholarship Amount Requested (up to 50% off)
*
$
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Family Information
Parent 1
Parent Name
First Name
Last Name
Home Phone
-
Area Code
Phone Number
Work Phone
-
Area Code
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent 2
Parent Name
First Name
Last Name
Home Phone
-
Area Code
Phone Number
Work Phone
-
Area Code
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Additional Information
Child's Gender
Male
Female
Other
Monthly Family Income (Gross)
$
Additional Income
Income ($)
Welfare AFDC
Child Support
Support from Spouse
Social Security
Income from 2nd Job
Other
Total Additional Income
Total Monthly Income
Please Explain the Reasons for Need
Submit
Should be Empty: