SICSA Campership Application 2023

SICSA Pet Adoption Center has a limited number of full and partial camperships for our Humane Education Summer Camps through the David Irwin Brown Humane Education Fund. Campership funds are offered so that students who otherwise could not afford to attend camps, can attend. Camperships are awarded based on the applicant's need and interest in animals and animal welfare.

Campership Application Guidelines:

Applicants are evaluated without regard to race, religion, natural origin, sex or physical ability
Funding is limited and camperships are not guaranteed to all applicants
Incomplete applications will not be reviewed
Camperships will be awarded based on need
First time applicants are given priority over applicants/families who have already been awarded a camperships within the same year or the previous year.

Summer Camp Camperships Recipient Requirements:

Submit completed application
Complete and submit follow-up report and/or letter after Camp
Please fill out one form per child

Name of Child

First Name

Last Name

Child's Birthday

(mm/dd/yyyy)

Guardian Email

Will be used only to communicate regarding application status, and instructions. This will be our primary method of communicating.

Verify Email

Phone

Street Address

City

Zip

What do you hope your child will gain from this experience?

To be completed by child:

Which SICSA Humane Education Camp would you like to attend and why?

Required Family Information

Parent/Legal Guardian Name

First Name

Last Name

Relationship to child

Financial Information

Eligibility for need-based camperships is based on household size and income standards. If an applicant does not fall within these criteria but can prove other special circumstances a camperships may still be granted.

*Household includes all people (adults and children) living in the household, related or not (grandparents, other relatives, friends, etc.).

Please indicate the number of people living in household

Are there any extenuating circumstances, permanent or temporary, that make financial assistance necessary at this time?

Are other family members currently applying for assistance?

Yes

Has anyone in your family previously received financial assistance through our campership fund?

Yes

If yes, when?

(mm/dd/yyyy)

How much was received?

Fee amount you are requesting:

Not to exceed $225

In addition to the fee, how much can you contribute?

Contributions are due by the first day of the week of camp attended.

By signing below, we are stating that the information outlined above is accurate, and that the amount of campership funds we are requesting is necessary in order for the applicant to be able to attend this program. I realize that funds for financial assistance are very limited and that receiving the full amount of funds requested is not guaranteed. In order to receive campership awards, participants must successfully complete the program, which means participants must attend, and complete the program without any disciplinary problems.

Parent/Guardian Signature

We would like permission to share excerpts from your application with donors

Yes, you may share these materials

No, pleas use these materials only for the application process