Scholarships are made available thanks to the generosity of: The Campfire Foundation & The Papoose Club
Scholarship Application Summer 2013 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(s) Name: _______________________________________________________________________ Which EcoCamp(s) are you requesting scholarship funding for: __ Water Explorations July 8-12 __ Amazing Adaptions July 15-19 __ Nature Connections July 29-August 2 __ Environmental Outdoor Leadership July 22-26
Please return this application by mail,e-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 or e-mail: allison@ercsv.org Please send this completed form to: Environmental Resource Center c/o Allison Marks P.O. Box 819 471 N. Washington Avenue Ketchum, ID 83340 208.726.4333 If received electronically send to: allison@ercsv.org
Did you include (or already send): The Program Registration Form � Yes � No $50 registration deposit per student � Yes � No *Deposit will be refunded if we cannot provide enough financial aid*
GENERAL INFORMATION Camper’s Name(s)_______________________________________________________________ Camper’s Date of Birth ___/___/___ 2nd 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? � Yes � No If yes, what year(s)? _________________ 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):