Anne's Scholarship Application Form

Anne's Scholarship Application Form

Camp Kooky
Name*

First NameLast Name
Contact Email
example@example.com
Phone Number

Area CodePhone Number
Date of Birth*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

List any siblings that are NOT attending camp.
Are any also attending? If yes list them here
First Name Last Name loves to fill in favorite activities He/She/ They do not enjoy least favorite activities

Parental Information
Name of Mother or Guardian*

First NameLast Name
Mother's Job/Position
Address of Mother

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name of Father*

First NameLast Name
Father's Job/Position
Address of Father (if not the same as above)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Financial Information
Your Family's Joint Annual Income*
Have you applied for scholarships with other organizations ?

YesNo
list organization

I AFFIRM THAT ALL STATEMENTS I HAVE INDICATED HEREIN ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE.
Applicant's Signature*

Clear
Date Signed by Applicant

MonthDayYear
Date
Give a brief summary as to why a scholarship would be helpful*
Should be Empty: