2020 Camp Financial Assistance Application (Full)

Camp Financial Assistance Application

Full Application
Student's Name

First NameLast Name
MaleFemaleNon-BinaryTransPrefer Not to Answer
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth

MonthDayYear
Phone Number
999-999-9999Format: (000) 000-0000.
Email
example@example.com
Grade in School
What School Do You Attend?
To be Completed by Student
If I receive financial assistance, I agree to follow all guidelines and policies set by the L.O.V.E. Academy and write a thank you letter to my sponsor(s).
In one paragraph, please state "Why I want to attend the Summer Empowerment Camp?
To be Completed by Student
Child's Signature
To be Completed by Parent / Guardian
Please make a brief statement describing why your child is in need of financial assistance.
To be Completed by Parent / Guardian
What is your occupation / job title?
What is spouse's occupation if applicable?

What is the combined/total annual household income: Check the appropriate box.

Rows	Under $20,000	$20,000-$30,000	$30,000-$40,000	$40,000 and Up
Income

The amount of assistance is based off a rolling tier.

The items listed below are to be transferred from your 1040: (Includes spouse's information is applicable).
Number of Dependents
Line 6C on 1040, Line 5on 1040 EZ or Line 6C on 1040A.
Adjusted Gross Income
Line 37 on 1040, Line 4 on 1040 EZ or Line 21 on 1040 A.
Total Income
Line 22 on 1040 or Line 15 on 1040 A.
List Special Circumstances (If Any)
YesNo
By signing this document, I agree that the information is accurate.
Parent / Guardian Name

First NameLast Name
Parent / Guardian Signature
References

To be completed by someone other than a family member. (Ex. Teacher, School Administrator, Scout Leader, Pastor, etc.) Please include a brief statement made by the reference of your choosing, a reference signature, and the relationship to the child. References can be emailed to kim@loveacademynashville.org.

Please make a brief statement describing why this child deserves a scholarship.

References can be sent using the file upload tabs below or can be emailed.
Recommendation Letter One:

Cancelof
Please Note: Financial assistance is not guaranteed. It will be determined based on the viability of your application. Scholarships may cover full tuition (minus the required $100 deposit) or a partial deduction. Assistance will be given based on the availability of funds and level of need.

Please write a descriptive account of why your child is in need of financial assistance.

This application is confidential. The information on the form will not be disseminated.

We will notify applicants of the award amount within by May 1st.

Need is the most important priority for the Financial Assistance Program.
Should be Empty:

Camp Financial Assistance Application

To be Completed by Student

To be Completed by Parent / Guardian