2017 Camp Scholarship Application
Personal
County of Residence: *
Name of Child: *
Your answer
Date of Birth: *
MM
/
DD
/
YYYY
Parent/Guardian Name: *
Your answer
Address: *
Your answer
Phone Number (no dashes): *
Your answer
Email Address: *
Your answer
Camp Information
Scholarships will be awarded for any camp, not just autism specific camps.
Name of Camp: *
Your answer
Camp Section/ID # (if applicable):
Your answer
Date(s) of Camp: *
Your answer
Total Cost of Camp: *
Your answer
Child is Already Registered at a Camp: *
Camp Contact Name: *
Your answer
Camp Contact Phone Number: *
Your answer
Camp Email Address:
Your answer
Camp Payment Address: *
Your answer
Proof of Autism Diagnosis
All applicants must provide proof of an autism spectrum disorder (e.g., front page of IEP, letter from doctor on letter head).
I will email proof of my child's disability to info@autismsupport-somd.org. *
I will mail proof of my child's disability to The Autism Spectrum Support Group of SoMD, P.O. Box 2162, California, MD 20619. *
Note: Applications will not be considered until proof of disability is received.
Policy:
Application information and proof of autism diagnosis must be provided for the application to be processed.

There are a limited number of camp scholarships, up to $150, available for individuals with autism in Calvert, Charles, and St. Mary’s counties. Scholarships will be awarded on a first come, first served basis (by postmark or email time stamp).

Applications must be received no later than May 15, 2017.

Recipients of scholarship awards will be notified by phone or email no later than June 1, 2017.

Scholarship monies will be paid directly to the camp program designated above. We do not provide reimbursements to parents. If you have already paid for camp, it is your responsibility to verify with the camp that monies you have paid would be refunded to you.

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