Unit Request of Membership Fee Assistance for Families

Membership Fee Assistance Request Form for Families

This form is for families in need to request up to $70/scout for assistance with annual membership fees. A separate form is available for camperships.
Parent Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent Email
example@example.com
Parent Phone
Please enter a valid phone number.Format: (000) 000-0000.
Name of Scout/Potential Scout

First NameLast Name
Age of Scout/Potential Scout?
Currently registered in Scouting?
If registered, with what type of unit?

Other
If registered, what is your unit number?
Ethnicity
Family's Household Income
On Public Assistance?
How many dependents under 18 live in your household?
List the age of each dependent under 18 in your household, one at a time:
If currently registered in Scouting, what is your family's fundraising participation (check all that apply)
Assistance Amount Requested:
Request up to $70.00
What school does your child attend?
Should be Empty:

Membership Fee Assistance Request Form for Families