Campership Application Form Page 3
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Scout’s Name:_________________________________________________________ DOB: ____/_____/__________
Street Address: ___________________________________________________________________________________
City, State, Zip: ___________________________________________________________________________________
Home Phone: (_____) _____-__________ Parent’s Name(s): ______________________________________________
Unit Type:__________ Unit #:________Council: __________________________District:_________________________
Age__________
Rank ___________
# Years in Scouting _______
# Years attended camp in past _______
# Years received a campership in past _______
Campership Request
Please check camp attending: (You must be registered for camp, camperships will not be granted to Scouts
whose troop is not yet registered.)
Camp Jeffrey
Camp Laramie Peak
Elkhorn
Nicol Cub Scout Camp Week #____ Dt__________
Cost of Camp
$_________________
Less Cost Provided by Scout & Family
- $_________________
Less Cost Provided by the Unit
- $_________________
Less Cost Provided by the Chartered Partner
- $_________________
Net Campership Request
$_________________
Briefly, explain what the Scout has done to earn a portion of his camp fee. Include Council, unit and
individual fundraising activities and service work performed.
Scout’s Popcorn Sales Last Fall - $______________
________________________________________________________________________________________
________________________________________________________________________________________
Family Information
This section must be completed by the Scout’s family. Briefly, describe the circumstances that require
campership assistance for the Scout to attend camp.
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
Total yearly household income (check one):
Under $17,000
$29,000 to $34,000
$47,000 to $52,000
$17,000 to $23,000
$34,000 to $40,000
$52,000 to $60,000
$23,000 to $29,000
$40,000 to $47,000
Over $60,000
In most cases camperships are not granted to families who have an income over $60,000.
Name and Age of other children (under 18) in the home:
1.____________________
4.____________________
7.__________________
2.____________________
5.____________________
8.__________________
3.____________________
6.____________________
9.__________________
Parent Signature: _____________________________________ Date: __________________
Email address:_______________________________________________________________
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