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 Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent Email
*
example@example.com
Parent Phone
*
Please enter a valid phone number.
Name of Scout/Potential Scout
*
First Name
Last Name
Age of Scout/Potential Scout?
*
Currently registered in Scouting?
*
Yes
Have never been registered
My registration has lapsed
If registered, with what type of unit?
Cub ScoutPack
Scouts BSA Troop
Crew
Ship
Exploring Club
Exploring Post
Other
If registered, what is your unit number?
Ethnicity
*
Please Select
Hispanic or Latino
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Unknown
Family's Household Income
*
Please Select
$0-$30,000
$31,000-$45,000
$46,000-$55,000
$56,000-$65,000
$66,000-$75,000
$66,000-$85,000
$86,000-$100,000
$101,000-$110,000
$111,000-$150,000
$151,000+
On Public Assistance?
*
Yes
No
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)
*
New scout - have not been able to participate yet
Participated in popcorn sales
Participated in other unit fundraiser that puts funds into my scout account
Participated in other unit fundraiser that provides funds to the unit
My unit does not do any fundraising
Assistance Amount Requested:
*
Request up to $70.00
What school does your child attend?
Submit
Should be Empty: