2021 Camp Scholarship Application

Contact Information

Child First Name *

Child Last Name *

Child's Age *

Child Grade (fall 2019) *

Identifies as (gender) *

Parent First Name *

Parent Last Name *

Mailing Address *

City *

State *

ZIP *

Email *

Phone *

Number of sibling(s) in the home: *

Ages of sibling(s):

Has your child received a scholarship for our education program before? *

Yes No

If yes, what year(s) and session(s)?

Why is a scholarship needed in order for your child to attend our program? List any extenuating circumstances.

How will your child benefit from receiving a scholarship? Please elaborate.

What other activities will your child be involved in? (For example: family vacations, church camp, school programs, etc.)

Education Session Selection

Please choose from the following sessions: *

Summer Camp Tuesdays Afterschool Program Wednesdays Afterschool Program Thursdays Afterschool Program Fridays Afterschool Program

How Much Can You Afford to Pay?

Our scholarship program is funded by donations and grants. While we do have limited full scholarships, we have more partial scholarships that can only be used in partial capacity as per the terms of our grant. If you can make partial payment, it may increase your chances of being awarded funding.

Self Assessment
You do not need to share your replies with us.

PART A

No = 1 Yes = 0

Do you own the home you live in?
Do you have investments, retirement accounts, inheritance money?
Do have access to family money in times of need?
Do you travel recreationally?
Do you work part-time by choice?
Do you have a high degree of earning power due to level of education (or gender or racial privilege, class background, etc)
TOTAL PART A (Maximum 6 pts): ____________

PART B

No = 0 Yes = 1

In the last 6 months, did you or your family:

Cut the size of your meals or skip meals because there wasn’t enough money for food?
Eat a less nutritionally balanced diet because there wasn’t enough money?
Are you supporting children or have other dependents?
Are you a single parent?
Do you have significant debt?
Do you have medical expenses not covered by insurance?
Do you have tuition/education expenses?
Do you receive public assistance?
Do you have immigration-related expenses?
Are you a senior citizen?
Are you a veteran or active military member?
TOTAL PART B (Maximum 11 pts): _____________

This scale is intended to help you look at your financial resources and take a deeper look at different levels of financial privilege. Make an honest assessment. The chart below is only intended as a guide. We believe you will pay what you can afford.

Add the points of Part A and Part B and please refer to the matrix below.

6-9 pts = 20-40% discount
10-13 pts = 40-60% discount
14< pts = 60-80% discount

How much are you able to pay weekly? *

Thank you for filling out your child's scholarship application. Our administrative coordinator will be in touch with you within the next two weeks.

PHILLIES BRIDGE FARM PROJECT 2021 EDUCATION SCHOLARSHIP APPLICATION

Education Session Selection