Camp RISE Scholarship Application Form

Camp RISE Scholarship Application Form

Camp RISE is specifically designed for children ages 4-14 with special needs. At Camp RISE, we are dedicated to helping every camper realize their potential. Our program focuses on fostering a sense of accomplishment while providing lasting memories and essential life skills. This scholarship offers a unique opportunity for families to give their children the chance to grow, thrive, and be celebrated in an inclusive and supportive environment.
Child's Full Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Child's Gender

MaleFemale
Grade Level:
Parent Information
Parent 1
Parent Name

First NameLast Name
Home Phone
Work Phone
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent 2
Parent Name

First NameLast Name
Home Phone
Work Phone
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Hosuehold Income:

Please indicate the household income range for the past year, including all sources of income (e.g., employment and/or government assistance).Disclaimer: The collection of household income information is a necessary component of the scholarship application process to ensure fair and equitable distribution of funds and to assess the overall impact of funding efforts. All personal information will be kept confidential and used solely for scholarship, grant, and funding purposes.
Range from 30,000-50,000Range from 50,000 -75,000Range from 75,000- 100,000Range from 100,000 and above
Does your child have a diagnosis? (Please specify):
Does your child have an Individual Education Plan/504 Plan? (Please specify):
Does your child currently receive special education services or therapy? (Please specify):

Camp RISE Scholarship Application Form

Parent Information

Hosuehold Income: