Healing Reins Summer Camp Scholarship Application

2026 Healing Reins Summer Camp Scholarship Application

If you would like to apply for scholarship assistance for yourself, your family, or other members of your household, please make sure you (or they) have registered as Healing Reins participants first and then fill out this form for your entire household to apply for scholarship assistance. Please note that we receive financial support from a wide variety of funding sources; the more information you can provide, the more we will be able to apply for and match you with scholarship funding. If you have any questions or need further assistance, please contact our administrative team.
Name of Person Completing This Form

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Household Information
Household Members: Please provide the names of the members of your household who are enrolled in Summer Camp at Healing Reins. **Please note that scholarship applications will not be processed until after the participant has been registered for at least one week of summer camp.
How many wage earners are there in your household?
How many total members are there in your household?
Enrollment Information
Demographic Information

This information is requested by many of our current funders and helps us apply for continued funding. We only share participant data aggregate. We do not share individual details without your express permission.
Age. If you are applying for more than one household member, please click the "plus" sign to add ages of all household participants. While specific data will help us apply for scholarship funding, you can type "prefer not to say" if that is your preference.
Does anyone in your household have an IEP, IFSP, or 504 plan on file with their school? Check any / all that apply.
What races / ethnicities do the members of your household identify as? Check and/all that apply

Other
Is the participant currently in child or adult foster care or is the participant an adult with a legal guardian?
Other Demographic Data: Please select any / all that apply to you or the members of your household who participate at Healing Reins:
Financial Information

Please include all sources of income, all types of financial support, and all assets for all members of your household. Failure to report all types of income and assets available to your entire household may result in a denial of scholarship funding. If you have any questions, please contact the Healing Reins administrative staff.
How much is your total MONTHLY household income (before taxes) ?
How much is your total annual household income (before taxes) ?
What are the current sources of income or financial support for your household? (check all that apply)

Other (please describe):
Do You Own Your Own Home or Rent?
How much is your rent per month?
How much is your monthly mortgage payment?
What is the current estimated value of your home?
How much do you still owe on your mortgage?
Please choose the range that best fits your household's total financial assets
Please include bank accounts (savings, checking, money market, CDs), investments (stocks, bonds, mutual funds, etc), vacation or investment properties owned, value of any luxury vehicles, boats or planes, other luxury items, individual retirement accounts. If you own your own home and reported your home value above, do not include the value of your main residence.
Does anyone in your household currently receive any of the following? (check all that apply)
What is your household's estimated monthly, out-of-pocket (not reimbursed) medical care costs?
Have you, or anyone in your household, had problems paying medical bills in the past 12 months?
Do you, or anyone else in your household, have any other income, receive any financial support, or own assets that have not been included yet in this application?
Please list the additional sources of income and amount, financial support and amount, and any assets and their current value (can be estimated).
Certification & Agreement
Signature
Should be Empty:

2026 Healing Reins Summer Camp Scholarship Application

Household Information

Enrollment Information

Demographic Information

Financial Information