Leadership Retreat Financial Assistance Form 2017
Financial assistance for Camp UKnight and the Discovery Program will be awarded based on need and the availability of funds. Upon completing this form, your spot will be reserved and we will be in contact with you regarding the status of your request at a later date.
Student Information
First Name
Your answer
Last Name
Your answer
Date of Birth
Your answer
Gender
Your answer
Street Address
Your answer
City
Your answer
State
Your answer
Zip Code
Your answer
Cell Phone No.
Your answer
Email
Your answer
RUID (9 Digits)
Your answer
What is your intended major?
Your answer
T-Shirt Size
Incoming Student Status
Anticipated Graduation Date
Your answer
Emergency Contact Full Name
Your answer
Emergency Contact Phone No.
Your answer
Emergency Contact Email
Your answer
Do you have Medical Insurance?
Who is your medical insurance provider? (Company)
Your answer
Who is the policy holder of your medical insurance? (Full Name)
Your answer
What is your medical insurance policy number?
Your answer
Special Dietary Restrictions
(E.g. Vegetarian, Vegan, Pescetarian, Kosher, Halal, etc.)
Your answer
Other Accommodations
Your answer
How did you hear about this event?
Your answer
Financial Assistance
Which extended orientation program are you planning to attend?
If you are interested in the Discovery Program, please rank your preferences for the track you would like to attend.
If you are not interested in the Discovery Program, please answer with the last option for all three.
First Choice
Second Choice
Third Choice
Fourth Choice
I am not interested in the Discovery Program
Start With Service
Start With Adventure
Start With Advocacy
Start With Sustainability
Are you a current recipient of financial aid?
Please tell us why you are in need of financial assistance.
Your answer
Please describe the financial assistance you are requesting.
(Ex. Payment plan, amount waiver, scholarship)
Your answer
By checking "Yes," I understand that completing this form does not guarantee financial assistance. However, my spot will be reserved and I will be contacted by the Leadership & Experiential Learning staff regarding my request at a later date.
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