Youth Scholarship Application Form
Sponsored by: United Church of God, an International Association
NORTHWEST PRETEEN CAMP 2012—Due June 1, 2012
PERSONAL INFORMATION
Applicant's name (print): Last / First / Middle
Grade in School: / Sex: ¡ Male ¡ Female
Address:
City: / State: / Zip:
Birth Date: / Age by August 5, 2012 :
Home Telephone Number: ( ) / Cell Number: ( )
Your E-mail address:
Parent’s E-mail address:
ACTIVITY & PARTICIPATION INFORMATION
Are you requesting scholarship funds for one of the following?
As a: ¡ Camper ¡ Staff ¡ Other (explain)
Have you attended a United Youth Camp before? ¡ Yes ¡ No
If yes, when and where?
Do you regularly attend Sabbath services, Bible Studies and church activities? ¡ Yes ¡ No
Congregation:
Are you actively involved in local church service? ¡ Yes ¡ No
If yes, list areas where you serve:
Have you participated in service projects at church, school or your community? ¡ Yes ¡ No
If yes, please list and give a brief explanation.
Are you willing to be a full participant in this youth camp? ¡ Yes ¡ No
REASON FOR APPLYING
Why are you requesting a scholarship?
Please explain why you would like to attend this youth camp.
What do you hope to get out of this youth camp?
What do you think you can contribute to this youth camp?
Upon your return would you be willing to write a report describing the value and personal benefits you received from the youth camp you attended? ¡ Yes ¡ No
PARENT(S): Please briefly explain what you hope your son or daughter will learn from their experience at this youth camp:
TUITION / COSTS
What have you done to save and/or earn money to be able to attend this youth camp this year?
Have you received a youth scholarship to attend a youth camp in the past? ¡ Yes ¡ No
If yes, when and what amount did you receive?
Total amount of tuition for the youth camp you want to attend:
Estimated cost for transportation:
Personal funds my family and I can contribute to the cost of this youth camp:
Total amount of scholarship requested:
AGREEMENT
I hereby certify that the statements made on this form are true and correct and make this request for a youth scholarship:
X ______
Applicant Date
X ______
Parent(s) / Guardian Signature(s) Date