Campership Request Individual

MIDLANDS MISSION CENTER

CAMPERSHIP FUND APPLICATION

Procedures:
1. Complete and submit this form if you are requesting funds to attend a Youth Camp or Family Camp.
2. The form must be submitted at least 2 weeks prior to the start of the activity.
3. The Mission Center President and/or Financial Officer will review completed forms. Applicants will be notified following a decision.
4. Separate forms must be submitted by each individual applicant.
Name of Applicant

First NameLast Name
Address
Age (at time of activity)
Parent/Guardian

First NameLast Name
Phone
Format: (000) 000-0000.
Email
example@example.com
Congregation
Camp/Activity Attending
Camp Start Date

MonthDayYear
Date
Briefly describe the reasons you feel this scholarship is needed
Amount I can pay towards the camp/activity
Amount requested from Midlands Campership Fund
I understand that the campership fund is specifically for those in financial need. I also understand that no one should be denied the camping experience because of lack of funds and that there are many other people in financial need as well as myself. I pledge a strong effort to work and save money for my own support to attend a camping activity.
Signed
Date

MonthDayYear
Date
Should be Empty: