Scholarship Request Form
If you, or someone in your family, would like to attend a CCC sponsored camp or retreat, but simply cannot afford it, you might be eligible to receive financial assistance. It is our desire that no one would miss out on one of our camps/retreats due to financial hardship.

Please fill out this form in it's entirety. Approval of each scholarship request takes about two weeks but can be rushed on an as needed basis. Applicants will then be contacted by a CCC staff member or the event coordinator. All information will be held strictly confidential within CCC leadership.

Email address *
First name of event Attendee: *
Your answer
Last Name of event Attendee: *
Your answer
Name of event you are requesting financial assistance for? *
Your answer
Date of event: *
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If attendee is under 18, name of parent or legal guardian:
Your answer
Relationship to Attendee:
Your answer
Phone Number: *
Your answer
The cost of camp is: *
Your answer
I am able to pay: *
Your answer
What type of financial assistance do you need? *
Please explain, in as much detail as possible, the circumstances for your request for financial assistance: *
Your answer
Please describe the extent to which you are involved at CCC: *
Your answer
Is there any additional information you would like to give us?
Your answer
Please type your full name to acknowledge the above statements: *
Your answer
Date of statement: *
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