Scholarship Request Form
Junior High Scholarship Request Form Summer Camp 2017 (July 1-5) Deadline: June 4, 2017 This application must be completed and submitted on or before June 4. You will be contacted with information about your request in the week following the scholarship application deadline. Please note: Your scholarship request does not hold your space for the camp. Because space is limited, it is recommended that you still submit your $50 deposit and medical consent and registration form.
Name: ____________________________________________ Phone: _______________________________________ Email Address: ____________________________________________________________________________________ (Please print clearly. An email will be sent to you confirming the scholarship amount you will receive.)
Address: ___________________________________________________________________________________________ City: _____________________________________________________________ State: __________ Zip: ___________ Small Group Leader: _______________________________________________________________ Grade: ______ Amount Requested: $ _________ *Please note: Because of limited funds, half scholarships are the maximum available.
Briefly explain why you want to go to camp: ____________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________
Briefly explain your reason for requesting a scholarship: __________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ Will you still attend camp without a scholarship?: ________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________
( Please Turn Over )
1.
Describe your involvement in Xchange ministry: __________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________
If you were the church, would you give yourself the scholarship? Why?: __________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________
You must have your parent / guardian and your small group leader (or staff member that knows you best) sign below: “I have talked with this student and he / she does have a genuine need for a camp scholarship.”
X _____________________________________________ Parent / Guardian (please print)
X _____________________________________________ Small Group Leader (please print)
X _____________________________________________ Parent / Guardian (Signature)
X _____________________________________________ Small Group Leader (Signature)
Office Use Only Scholarship Amount: $ ________________________ Balance Due: $ _________________________ Contacted: ______________________________ 2.
Name: ____________________________________________ Phone: _______________________________________ Email Address: ____________________________________________________________________________________ (Please print clearly. An email will be sent to you confirming the scholarship amount you will receive.)
Address: ___________________________________________________________________________________________ City: _____________________________________________________________ State: __________ Zip: ___________ Small Group Leader: _______________________________________________________________ Grade: ______ Amount Requested: $ _________ *Please note: Because of limited funds, half scholarships are the maximum available.
Briefly explain why you want to go to camp: ____________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________
Briefly explain your reason for requesting a scholarship: __________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ Will you still attend camp without a scholarship?: ________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________
( Please Turn Over )
1.
Describe your involvement in Xchange ministry: __________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________
If you were the church, would you give yourself the scholarship? Why?: __________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________
You must have your parent / guardian and your small group leader (or staff member that knows you best) sign below: “I have talked with this student and he / she does have a genuine need for a camp scholarship.”
X _____________________________________________ Parent / Guardian (please print)
X _____________________________________________ Small Group Leader (please print)
X _____________________________________________ Parent / Guardian (Signature)
X _____________________________________________ Small Group Leader (Signature)
Office Use Only Scholarship Amount: $ ________________________ Balance Due: $ _________________________ Contacted: ______________________________ 2.
