Summer Camp Scholarship

Summer Camp Scholarship
Application for Summer Camp Scholarship

Please complete the application. The Arc will choose recipients based on timeliness of application, financial need, and overall applicability of summer camp chosen.
Client Name
Date of Application

MonthDayYear
Date
Race
Date of Birth

MonthDayYear
Date
Clients Parent/Guardian
Guardian's Phone
Address
EMail Address
example@example.com
Address
Diagnosis
What services does the client currently receive for their diagnosis?
Name of summer camp program
School or Day Program
Location
Duration
Cost of program
Amount being requested
Have you requested a scholarship from the camp? If so, how much have they awarded.
Brief description of how the summer camp program would benefit the client:
Annual household income
Number of adults in household
The number of people in the household with disabilities
Please explain financial need if household income is greater than $30,000:
GuardianParent Signature

Clear
Date

MonthDayYear
Date
Would you be willing to provide a photograph?
PO Box 1365 Asheville, NC 28802 Phone: (828) 253-1255
Should be Empty: