Adirondack Scholarship Foundation, Inc. · 2024 Scholarship Application

CAMPER INFORMATION

How many children are applying?

Applicant #1

Name of Child:

*

Age on July 1, 2024:

*

Gender:

Current School:

*

Is the applicant of Hispanic, Latino, or Spanish origin?

*

In how many previous summers has the applicant attended Pok-O-MacCready Camps?

*

Did the applicant attend Pok-O-MacCready Camps during the summer of 2023?

*

Will this applicant have a sibling at camp this summer?

Yes

Applicant #2

Name of Child:

Age on July 1, 2024:

Gender:

Current School:

Is the applicant of Hispanic, Latino, or Spanish origin?

*

In how many previous summers has the applicant attended Pok-O-MacCready Camps?

*

Did the applicant attend Pok-O-MacCready Camps during the summer of 2023?

*

Will this applicant have a sibling at camp this summer?

Yes

Applicant #3

Name of Child:

Age on July 1, 2024:

Gender:

Current School

Is the applicant of Hispanic, Latino, or Spanish origin?

*

In how many previous summers has the applicant attended Pok-O-MacCready Camps?

*

Did the applicant attend Pok-O-MacCready Camps during the summer of 2023?

*

Will this applicant have a sibling at camp this summer?

Yes

FAMILY INFORMATION

What is the family’s primary language spoken at home?

*

English

Language other than (or in addition to) English

Prefer not to answer

Parent or Guardian Involvement

*

Does the applicant live in a single-parent household?

PARENT or GUARDIAN #1

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:

*

PARENT or GUARDIAN #2

Name

*

First Name

Last Name

Address is the same as above

Yes

Address

*

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Email

*

Verify Email

*

Phone

*

Occupation:

*

Employer:

*

FINANCIAL INFORMATION

AID REQUEST

2024 Tuition Rates:

7-Weeks ($9,700) 4-Weeks ($7,500) 3-Weeks ($5,500)
2-Week ($3,900) Day Camp ($625 per week; 2 or 3 weeks)

"Pok-O Wild" Adventure Program ($3,750)

Farm Camp ($625; 1-Week, Day)

Certain discounts may apply. Contact camp.

Knowing the above rates, and the number of children applying for aid,

My 2024 Scholarship Request is:

*

Our preferred camp session is*

*

* Scholarship may be applied towards any session. Families are generally responsible for the balance of tuition + most expenses

INCOME STATEMENT

All information provided will be kept in strict confidence. The foundation may request an applicant’s tax returns, and should that request be denied, it is understood that this may decrease the applicant’s chances for receiving financial aid.

How will you file your taxes for the year ending 2023?

*

Adjusted Gross Income from prior year tax return (Form 1040, line 8b)

*

Guardian #1

Adjusted Gross Income from prior year tax return (Form 1040, line 8b)

*

Guardian #2

Number of household members dependent on the above income:

*

Do you own or rent your home/apartment?

*

Monthly Mortgage:

*

Remaining Balance (principal)

*

What is your monthly rent?

*

Housing Assistance

Do you receive Section 8 housing assistance or public housing?

Yes

Please specify any debts, changes to your income, or unexpected or unusual financial circumstances:

especially if circumstances have changed drastically since prior year tax return

Are there other family or friends (beyond parents/guardians) involved with paying for camp?

If yes, please explain.

SUPPORTING INFORMATION

Please feel free to upload a cover letter, and 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)

Upon hitting the submit button, you will be directed to a page containing additional "CAMPER QUESTIONNAIRE" and "REFERENCE" forms.

Before submitting, please note that your application will not be considered complete unless you have been in touch with Pok-O-MacCready Camps about your desire to enroll the applicant for the Summer 2024 if financial assistance allows. CONTACT Brian DeGroat: brian@pokomac.com / (518-963-7656 ext. 1)

Given this information, choose the statement from the drop-down menu that best applies to you:

*

2024 Scholarship Application

ADKSF provides assistance to the families of children from all races, genders, orientations, abilities, and other identities without discrimination.

CAMPER INFORMATION

Applicant #1

Applicant #2

Applicant #3

FAMILY INFORMATION

FINANCIAL INFORMATION

SUPPORTING INFORMATION

Upon hitting the submit button, you will be directed to a page containing additional "CAMPER QUESTIONNAIRE" and "REFERENCE" forms.