Page 1 Camper(s)&Parent Information

• • • How many children you are requesting assistance for, as well as the sessions enrolled for in 2021
    • Parent’s Names & Parent’s Contact Information

Page 2: Financial Information

• • • Professions of each parent (s) (required if both parents support the child)
    • 2020 Salary (required if both parents support the child)
    • Yearly Untaxed Income and Benefits (please include Social Security, AFCS, Child Support and any other Assistance)If none – you will type none
    • Medical and Dental Expenses Not Paid by insurance (exclude premiums)
    • Total Cash, Checking, Saving, and Cash Value of Stocks (exclude retirement plan funds, IRA and 401K)
    • Total number of family member residing in the household and primarily supported by the reported income
    • Total number of family members attending college at least half of 2020-2021 school year

Page 3: Campership Request

• • • Please explain why a scholarship is needed; Please provide any information that would be helpful to know; unusual expenses you had in the past year or expect next year, significant changes in income in recent years, illness, housing or employment difficulties, debts.
    • We recommend you have this available in Word to readily cut and paste into the application
    • Please have other scholarship award amounts available. It is Jacobs Camp’s expectation that families will submit scholarship requests to any available local (congregation, federation) and/or regional (JCRS). If you have not yet been awarded scholarship but have put in an application, please let us know that as well.
    • First-Time Campers incentives are available; if you have already applied please indicate the source and amount.
    • Amount you and/or family are able to contribute
    • Scholarship amount requested