The Campfire Foundation, Inc
Deer Creek Fund in the Idaho Community Foundation
Scholarship Application Summer 2011 Financial assistance is awarded based on applicant’s demonstrated need and available funds. To help determine the need of each family, we require the parents to complete the following confidential form and return it to the ERC. Applications are considered on a continual basis for as long as funds are available, beginning in early May – apply early! Please fill out separate application for each child that you are requesting scholarship funds. Are you filling out more than one application? Yes No Student Name: _______________________________________________________________________ Which EcoCamp(s) are you requesting scholarship funding for: 1st Camp Preference_____________________________________________ 2nd Camp Preference (if applicable) ________________________________ 3rd Camp Preference (if applicable) ________________________________ Please Note: Financial aid recipients for EcoCamp 2011 must be entering grades 4 – 7 in the fall. Unfortunately, due to the price of Adventure Aquatic, we are only able to offer limited scholarships for this particular camp. Please return this application by mail or in person as soon as possible. Please note that completing this form does not register your child in camp; you must complete a registration form and make a $50 deposit. The more information you provide, the easier it will be for the scholarship committee to make an informed decision. This application is confidential and information will not be shared with anyone else. Questions? Please call 208.726.4333 x 6 or e-mail: hadley@ercsv.org Please send this completed form to: Environmental Resource Center P.O. Box 819 471 N. Washington Avenue Ketchum, ID 83340 208.726.4333 Did you include (or already send): The Program Registration Form
Yes
$50 registration deposit per student
No
Yes
No
*Deposit will be refunded if we cannot provide enough financial aid*
GENERAL INFORMATION Camper’s Name _______________________________________________________________ Camper’s Date of Birth ___/___/___
1) Parent/Guardian ____________________________________________________________ Address ______________________________________________________________________ City _____________________________________________ State ______ ZIP _____________ Telephone (day) ________________________ (evening) ______________________________ E-mail _______________________________________________________________________ Occupation ___________________________________________________________________
2) Parent/Guardian ____________________________________________________________ Address ______________________________________________________________________ City _____________________________________________ State ______ ZIP _____________ Telephone (day) ________________________ (evening) ______________________________ E-mail _______________________________________________________________________ Occupation ___________________________________________________________________
Were you referred by anyone? If so, by whom ______________________________________
FINANCIAL INFORMATION Number of children in family that you claim as dependents ___________________________ Taxable household income from last year’s tax form _________________________________ Other sources of income (alimony, friends/relatives) _________________________________ This application reflects financial information for the household of: ________________________
Does your family participate in the following programs? Free/reduced lunch Yes No Food stamps Yes No State Cash Assistance Yes No Foster child Yes No Other:
Have you previously received financial aid for EcoCamp? If yes, what year(s)? _________________
Yes
No
The ERC may not be able to award financial aid for the full cost of a camp session. What would be the most you can contribute to allow your child to attend camp? $_____________
I / We, the undersigned, affirm the above information is true. (1) Parent/Guardian: ____________________________________ Date: ______________ (2) Parent/Guardian: ____________________________________ Date: ______________
Please explain any extenuating circumstances you would like the Financial Assistance Committee to consider (attach additional page if necessary):
CAMPER ESSAY To help us secure funding for your scholarship, we would like your child to write a short essay telling us why they would like to attend EcoCamp. Please attach an additional page if you would like. Thank you!
__________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________