Campership Application Form - 2016 (Page 2 of 2) in pdf

2016 CAMPERSHIP APPLICATION

DUE March 1

, 2016

PLEASE PRINT CLEARLY ● ONE FORM PER CAMPERSHIP APPLICANT

*Scout Unit:  PACK  TROOP  CREW _________

A Campership is requested for: (Please print information)

*Scout’s Name ____________________________________ *District _________________________________________

*Parent’s Name ___________________________________ *Leader’s Name __________________________________

*Address _________________________________________ Unit Position ______________________________________

*City/Zip _________________________________________ *Address _________________________________________

Phone # __________________________________________

*Email __________________________________________

* Email __________________________________________

*City/Zip _________________________________________

Age ______

*Birth Date___________ Rank___________

Phone # __________________________________________

If the Scout is an American Indian, the Council may access funds through the Maury Clancy American Indian Campership

program. Does the Scout qualify as an American Indian?  YES  NO Tribe: ___________________________________

* Camp Attending__________________________________ * Camp Dates _____________________________________

* Program Attending________________________________ * Family Income $ _______________* Family Size ______

* Program Fee $____________________________________ * Amount Requested $_______________________________

* Briefly describe this applicant’s Scouting history.

* Briefly describe the financial situation on which this campership request is based.

Did the Scout participate in the Popcorn Sale? *  YES  NO

Total Amount of Popcorn Sold $___________

* Describe other fundraising opportunities that have been or are being pursued to earn money for camp.

* Leader’s Signature

* Parent’s Signature

Date

When completed, send this form to:

For Campership Selection Committee Use:

Campership Selection Committee

Date Received ________________ Date Processed ___________________

Simon Kenton Council, BSA

Amount Requested $______________ Amount Awarded $______________

807 Kinnear Road Suite 200

Reason ________________________________________________________

Columbus, Ohio 43212

Campership Applications are Due BY MARCH 1ST!

* Must be completed!

Campership

2016

Campership Application Form - 2016 Page 2