Camp Good News Scholarship Application Form
Please be prepared to fill one form per child
Camp Location
*
Please Select
Newtown
Telford
Weeks Requesting Scholarship For
*
July 1-3 (Week 1) - Surprise Adventure
July 8-12 (Week 2) - Artic Freeze
July 15-19 (Week 3) - Carnival of Colors
July 22-26 (Week 4) - Ocean Odyssey
July 29-August 2 (Week 5) - Creative Arts
August 5-9 (Week 6) - Sports Spectacular
Child's Full Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Child's Gender
Male
Female
Scholarship Amount Requested
*
$
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Family Information
Parent 1
Parent Name
*
First Name
Last Name
Cell Phone
*
-
Area Code
Phone Number
Home Phone
-
Area Code
Phone Number
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent 2
Parent Name
First Name
Last Name
Cell Phone
-
Area Code
Phone Number
Home Phone
-
Area Code
Phone Number
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Are there Other Children in the Family?
*
Please Select
Yes
No
Other Children in Family
Please Add All Other Children in Family
*
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Additional Information
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: