DFI Title XX Camping Services Agency Partner Application 2026

DFI Title XX Camping Services Agency Partner Application 2026
- 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 numberFormat: (000) 000-0000.
- 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?
- 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 numberFormat: (000) 000-0000.
- 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 numberFormat: (000) 000-0000.
- Mailing Address: This is the address that payments will be mailed to.
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Make Checks Payable to:
- Please upload a completed and up to date W9 form for your agency.
  
  Cancelof
- 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 numberFormat: (000) 000-0000.
- Name of Camp Registrar
- Email of Camp Registrar
  example@example.com
- Phone Number of Camp Registrar
  Please enter a valid phone numberFormat: (000) 000-0000.
- 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?
- Risk Management Plan - Required for all Camps
  
  Cancelof
- 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?
- Upload your Custom Registration Form here
  
  Cancelof
- 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)?
  
  Other
- Name of Camp Director
- Email of Camp Director
  example@example.com
- Phone Number of Camp Director
  Please enter a valid phone numberFormat: (000) 000-0000.
- Did your agency participate in the DFI Title XX Camping Services Program in Summer 2025?
- Does your agency understand each camper can attend a maximum of one session per summer funded by the DFI Title XX Camping Services Program?
- Does your agency understand that it will receive a specific allocation that outlines the maximum number of days or nights that can be billed per camper? This number may not be equal to your full session length. This number is provided during the allocation notification for agencies approved for funding.
- Does the agency understand that the agency must notify ACA Illinois of any change in leadership of either the agency (CEO, CFO, etc.) or camp contacts (Camp Director, Registrar, etc.) listed on this application within 15 days of that change?
- Does your agency understand that this application cannot be transferred to another agency or camp?
- Does your agency understand that they must keep General Liability Insurance and provide a Certificate of Insurance listing American Camp Association, Illinois as additionally insured?
- Does the agency understand that camps that receive this funding must be open to taking Referrals from the ACA Illinois / IDHS Client Camp Referral Hotline Program?
- Is your camp ACA Accredited?
- Name of the person completing this application.
- Signature of the person completing this application.
- Should be Empty:

DFI Title XX Camping Services Agency Partner Application 2026

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.