Adirondack Scholarship Foundation, Inc. · 2021 Deferred Scholarship Application

CAMPER INFORMATION

How many children are re-applying?

Applicant #1

Name of Child:

*

Age on July 1, 2121:

*

Applicant #2

Name of Child:

Age on July 1, 2121:

Applicant #3

Name of Child:

Age on July 1, 2121:

Parent Involvement

*

Which parents will be involved in the application and payment process?

If other, please explain:

*

PARENT INFORMATION

Has your address changed since in the past year

(Check box if yes)

Yes

FATHER or MALE GUARDIAN

Name

*

First Name

Last Name

Address

*

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Email

*

Verify Email

*

Phone

*

Occupation:

*

Employer:

*

MOTHER or FEMALE GUARDIAN

Name

*

First Name

Last Name

Address

*

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Email

*

Verify Email

*

Phone

*

Occupation:

*

Employer:

*

Will both parents be contributing towards tuition?

(for divorced/separated parents)

Yes

No

FINANCIAL INFORMATION

YOUR 2021 SCHOLARSHIP AWARD

Your 2021 amount will be the same as your 2020 offering. If you do not remember the amount, please CONTACT us.

Tuition Prices:

7 Weeks ($8400) 4 weeks ($6600) 3 Weeks ($4800)

Rookie Camp: $3250 Day Camper: $1900

Families are fully responsible for the balance of tuition + all expenses.

2021 Scholarship Status

*

(Please select one)

I am grateful to receive this award for 2021

I need to request a different amount for 2021

Our preferred camp session is*

*

* Scholarship may be applied towards any session.

Current Financial Status

Has your family income situation changed drastically during the past year?

Yes

No

Financial Change this Past Year

*

INCOME STATEMENT

An increase in your award for 2021 is not guaranteed - and unlikely - but if it's possible to qualify, we ask that you please update the financial information below.

The foundation's award committee will use your information to allocate extra funds, IF they are available.

As always, we reserve the right to request an applicant’s tax returns.

Household members dependent on the above income:

*

Total Annual Household Income:

*

Please explain your change in financial status

SUPPORTING INFORMATION

Please feel free to upload any supporting financial information that may be of help to our scholarship award committee.

E-SIGNATURE (Your name)

*

I certify that the information reported on this form is, to the best of my knowledge, correct and complete, and understand that the foundation reserves the right to request financial documentation.

Date

*

(mm/dd/yyyy)