Summer Camp Scholarship Application Form
Child's Full Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Race Identification (Select one or More)
*
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Pacific Islander
Other
Prefer not to say
Is your child of Hispanic, Latino, or Spanish origin?
*
Yes
No
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Family Information
Parent 1
Parent Name
*
First Name
Last Name
Home Phone
*
Format: (000) 000-0000.
Work Phone
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Parent 2 (If necessary)
Parent Name
First Name
Last Name
Home Phone
Format: (000) 000-0000.
Work Phone
Format: (000) 000-0000.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
example@example.com
Other children in family
Configurable list
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Additional Information
Monthly Family Income (Gross)
*
$
Is there an amount you could pay for a five-day,camp (cost is $120.00 for members of The Crossing Arts and $130.00 for non-members), if applicable?
*
$
Numbers don't paint the full picture. Can you please tell us a bit about your family situation?
*
Submit
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