DFI Title XX Camping Services Agency Partner Application 2026

Agency Information
This section is meant to capture the information for the agency, not just the camp. Specific site and camp information is uploaded in the Referral Program Information.
Agency Name*
Address of Agency / Main Office*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Your Agency's Main Contact for the DFI Title XX Program*

First NameLast Name
Title/Position within Agency*
Email of Main Contact*
example@example.com
Phone Number of Main Contact*
Please enter a valid phone number

Agency Details
Website*
Mission of Agency*
List of Board Members*

Cancelof
Brochure / Promotional Flyer*

Cancelof
Summer 2026 Session Plans Form*

Cancelof
How many seasonal staff do you employ each summer to support your camp programs?*
How many year round staff do you employ to support your camp programs? *

Agency Leadership Contacts
Name of CEO / Executive Director of Agency*
Email of CEO / Executive Director of Agency *
example@example.com
Phone Number of CEO / Executive Director of Agency*
Please enter a valid phone number
Name of CFO/ Finance Director of Agency*
Email of CFO/ Finance Director of Agency*
example@example.com
Phone Number of CFO / Finance Director of Agency*
Please enter a valid phone number

Financial Contacts
Contact Responsible for DFI Title XX Billing Form and Payments*
Title/Position of Contact Responsible for DFI Title XX Billing Form and Payments*
Email of Contact Responsible for DFI Title XX Billing Form and Payments*
example@example.com
Phone Number of Contact Responsible for DFI Title XX Billing Form and Payments*
Please enter a valid phone number
Name of Camp Registrar*
Email of Camp Registrar *
example@example.com
Phone Number of Camp Registrar *
Please enter a valid phone number

Supporting Documents and District Information
Please list the district and names of your State Representatives.*
Local IDHS Office including name, location and contact information.*
Does your agency understand that by receiving these federal funds, the agency can not discriminate or turn away clients/campers who are federally protected against discrimination?*

YesNo
Risk Management Plan - Required for all Camps*

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Linguistic & Cultural Competency Plan*

Cancelof
Referral Program Information Form*

Cancelof
Community Partnership Agreement*

Cancelof
Would your agency like to use a custom, agency-created Camper Registration Form in place of the standard IDHS and ACA Illinois form?*

YesNo
Upload your Custom Registration Form here*

Cancelof

DFI Title XX Camping Services Program Goals
The DFI Title XX Camping Services Program has four (4) goals and outcomes for campers/clients. In order for camps to qualify, their primary program and mission focus must be working towards the following goals:

1. The camper increased his/her ability to function more independently.

2. The camp increased her/his ability to positively interact with other campers.

3. The camper increased his/her acquisition of positive values.

4. The camper increased her/his ability to establish positive relationships with adults.

How these goals are implemented will look differently in each camp, however funding of this program requires campers achieve growth in these areas.
Share how your camp program works to help campers achieve these four goals.*
Do you have any concerns about maintaining a program that helps campers achieve these goals? If so, please share. If no concern, please leave blank. *
Does the camp agree, if funding is provided, to submit a report that monitors each camper's growth in ALL four goals (Submit a completed Camper Report for each camp with each bill)?*

YesNoOther

This section is meant to capture the information for the agency, not just the camp. Specific site and camp information is uploaded in the Referral Program Information.