Scholarship Assistance Application
​Please complete ONE FORM PER FAMILY! It is vital that you list any/all children who desire a scholarship to attend camp as well as their age and if they would like to attend Day Camp or Overnight Camp. Please be sure to list EVERYONE who lives in your home as well as all income that they may provide to your home. Information shared on this form will only be used to determine eligibility for scholarship assistance, and to verify that the information given is correct.

Please note, you should get a confirmation message saying your application has been submitted, if you do not receive this message, your application has not gone through. This message should appear in place of the actual application after submitting. It may take a few seconds for the confirmation to process and appear, please be patient and do not hit submit several times. If you have any trouble please contact KJ Kelly at 269-521-3559.

Email address *
Parent/Guardian Info
Please indicate the legal parent or guardians information below. We try to contact everyone through email, so please be sure to check your email regularly. We will need to contact you to verify the information you provide in your application as well as set up any potential scholarship. Please be sure this information is correct.
Guardian Name *
Your answer
Guardian Phone Number *
Your answer
Guardian Address *
Your answer
Family Financial Info
Please provide the request information in regard to your families financial situation.
2. How many individuals live in your household? This should include EVERYONE living in your home. Please list the number as well as the name of each person living in your home. *
Your answer
3. What is your total household income? This should be ALL income from any/all individuals living in your home. This should include work wages, child support, disability income, SSI, AFDC, Alimony, WIC, SNAP, and any Other Income. Please indicate if this is a yearly, monthly, Bi-weekly, or Weekly Total. *
Your answer
Does any member of you family have any special need or disability *
Please explain above indicated special needs or disabilities. *
Your answer
Are there any other special circumstances that should be taken into consideration? *
Please include any information you feel is important for us to consider when reviewing your application. Information provided here does NOT guarantee a scholarship will be awarded. We may require follow up information/verification based on the information provided.
Your answer
Child Info
Please list any children who you would like to be considered for scholarship as well as their age and the type of camp they would like to attend.
Child #1 Name *
Child's first and last name
Your answer
Child #1 Age *
Your answer
Child #1 Camp Type *
Required
Child #2 Name
Child's first and last name
Your answer
Child #2 Age
Your answer
Child #2 Camp Type
Child #3 Name
Child's first and last name
Your answer
Child #3 Age
Your answer
Child #3 Camp Type
Additional Children - please be sure to include Names, Ages and Day or Overnight Camp
Your answer
By "signing" below I certify that all information on this application is true and that all of our household income is reported. I understand that Camp Kidwell gets funding from various sources based on the information I give. I understand that Camp Kidwell officials may verify (check) the information. I understand that if I purposely give false information, my child may lose scholarship assistance and I may be prosecuted. I have been give all the time I need to read and understand this form. *
Required
Thank you for completing the scholarship application. We will contact you shortly to verify your income.
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service