Summer Camp Scholarship Application

Scholarships are available for 2021! If you would like to apply for a scholarship, please fill out the form below and submit. If you are a new family, please include your child's IEP or clinical evaluations. Applications are due April 2, 2021.

Please list all the programs and prices you wish to enroll your child in:
Total Price:
Personal Info
Student Name
First Last
Birthdate
Date Format: MM slash DD slash YYYY
Grade in the Fall
Please enter a number from 1 to 12.
Gender
Ethnicity
School Name (currently enrolled at)
For new families, please submit child's most recent IEP and evaluation
Drop files here or
Name of Parent(s) or Legal Guardian(s)
First Last
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Cell Phone(s)
Work Phone(s)
Home Phone(s)
Email(s)
Income Info
Total Yearly Gross Household Income (Salary, Wages, Commissions,etc.)
Agency Subsidy (Welfare, Social Security, etc.)
Other Income (Alimony, Child Support, etc.)
Please list total number of adults and children living on income represented above
Please provide a copies of income verification (W-2, Paystub, Voucher, SSI, etc.)
Drop files here or
*This information will be kept confidential and used only in determining financial eligibility.
Qualification Info
In order to make more scholarships available, we ask that you consider requesting a partial scholarship
- I request a 25% scholarship
- I request a 50% scholarship
- I request a 75% scholarship
In the space below, please describe the ACADEMIC reasons for requesting this scholarship
In the space below, please describe the FINANCIAL reasons for requesting these funds. Include any extenuating financial circumstances (medical, job loss, unusual expenses, etc.) or significant family expenses, including college and day school tuition.

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Summer Camp Scholarship Application

Personal Info

Income Info

Qualification Info