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 ?
list organization

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

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