Adirondack Scholarship Foundation, Inc. · 2022 Scholarship Application

CAMPER INFORMATION

How many children are applying?

Applicant #1

Name of Child:

*

Age on July 1, 2022:

*

Gender:

Current School:

*

How many summers has your child attended Pok-O-MacCready Camps?

*

Applicant #2

Name of Child:

Age on July 1, 2022:

Gender:

Current School:

How many summers has your child attended Pok-O-MacCready Camps?

*

Applicant #3

Name of Child:

Age on July 1, 2022:

Gender:

Current School: Copy

How many summers has your child attended Pok-O-MacCready Camps?

*

Does the family speak a language other than English at home?

*

English is our only language

Our family speaks more than one language

refer not to answer

Parent or Guardian Involvement

(Please indicate how many adults are involved with the application and payment for camp)

PARENT INFORMATION

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

2022 Tuition Rates:

7-Weeks ($9,400) 4-Weeks ($7,200) 3-Weeks ($5,400)
2-Week "Rookie Camp" ($3,700) Day Camper (tbd)

Certain discounts may apply. Contact camp.

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

My 2022 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.

WAGES, SALARIES, TIPS

*

Guardian #1

WAGES, SALARIES, TIPS

*

Guardian #2

B. Dividends, Interest, Profit, Alimony/Child Support

OTHER TAXABLE INCOME Copy

TOTAL ANNUAL INCOME

*

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?

*

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

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)

2022 Scholarship Application

CAMPER INFORMATION

Applicant #1

Applicant #2

Applicant #3

PARENT INFORMATION

FINANCIAL INFORMATION

SUPPORTING INFORMATION

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