Scholarship Request Form - Cedar Lake Camp

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Parents
Camps
Groups
Get Involved
- Work at Camp
- Partner
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Contact

Scholarship Request

Cedar Lake Camp & Retreat Center

Please fill out the form completely.

For questions or more info: 931-823-5656 or clcstaff@cedarlakecamp.org.

Scholarship Request Form 2024

"*" indicates required fields

Name of Family or Guardians:*

Address:*

Street Address Address Line 2 City State ZIP Code

Contact Name:*

First Last

Contact Phone:*

Email*

Church Name:*

Church Phone:*

Applying for Angel Tree Scholarship? (Child must have a parent/legal guardian that is incarcerated and has filled out the camper info form with Angel Tree):*

Father's Occupation:*

Father's Gross Annual Income:*

Mother's Occupation:*

Mother's Gross Annual Income:*

Total Number of Family living at home:*

Number of children attending camp:*

CHILD ONE:

Name:*

Age:*

Gender:*

Male

Female

DOB:*

MM slash DD slash YYYY

Grade Entering:*

Camp Program:*

Weeks you are applying for a camp scholarship

Day Camp Weeks:

Overnight Camp Weeks:

CHILD TWO:

Name:

Age:

Gender:

Male

Female

DOB:

MM slash DD slash YYYY

Grade Entering:

Camp Program:

Weeks you are applying for a camp scholarship

Day Camp Weeks:

Overnight Camp Weeks:

CHILD THREE:

Name:

Age:

Gender:

Male

Female

DOB:

MM slash DD slash YYYY

Grade Entering:

Camp Program:

Weeks you are applying for a camp scholarship

Day Camp Weeks:

Overnight Camp Weeks:

CHILD FOUR:

Name:

Age:

Gender:

Male

Female

DOB:

MM slash DD slash YYYY

Grade Entering:

Camp Program:

Weeks you are applying for a camp scholarship

Day Camp Weeks:

Overnight Camp Weeks:

CHILD FIVE:

Name:

Age:

Gender:

Male

Female

DOB:

MM slash DD slash YYYY

Grade Entering:

Camp Program:

Weeks you are applying for a camp scholarship

Day Camp Weeks:

Overnight Camp Weeks:

CHILD SIX:

Name:

Age:

Gender:

Male

Female

DOB:

MM slash DD slash YYYY

Grade Entering:

Camp Program:

Day Camp Weeks:

Overnight Camp Weeks:

Amount of scholarship desired:*

How much can you pay?*

Other Funding Sources:*

How much is available from other funding sources?*

Payment plan needed for balance after scholarship?*

Yes

No

If scholarship is awarded, how many payments will you need after the scholarship?*

If NO scholarship is awarded, how many payments will you need?*

Please explain your need:*

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