College Educational Assistance Eligibility Form
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1College Educational Assistance Eligibility Form
Camp Berea Summer Staff Program
st
Must be returned by June 1
Applicant s Name:_______________________________________
Name of parents:___________
Address:_______________________________________________
________________________
City:______________________ State:_____ Zip:______________
Occupation:______________
Telephone Number:______________________________________
Family Income:___________
Siblings &
Ages:___________
Name and Address of College/School you plan to attend:
________________________
________________________
College/School:_________________________________________
_______________________
Address:_______________________________________________
No.____ of children in college
City:______________________ State:______ Zip:______________
Telephone Number: ______________________________________
Anticipated Expenses:
Anticipated Financial Resources:
Tuition, books, & Fees: $_____________
Personal Savings:
$______________
Living expenses, if any: $_____________
Anticipated Income: $______________
Other (travel, etc.):
$_____________
Help from parents: $_______________
TOTAL: $_____________
Other grants, loans: $_______________
Anticipated Shortage
: Total Anticipated Expenses: $___________________
Total Anticipated Resources: $____________________
Total Anticipated Shortage: $____________________
It is my desire to participate in Camp Berea s summer staff educational assistance program. I am requesting to receive a
grant for $_____________(maximum $500). I realize that in order to receive this grant, I must (1) fully complete the
terms and dates of my employment agreement, (2) complete and turn in all paperwork for this program by May 1, 2010
(3) be deemed financially eligible, (4) be a positive role model and leader in the Camp Berea family and community, and
(5) be recommended for rehire by the administration and my department head.
I also understand that in the future as God blesses me financially, I will consider giving back into this fund which enables
so many to work at camp who are temporarily in need.
Signature of Applicant:______________________________________________ Date:____________
Please check ONE of the following:
____ I have enclosed a photocopy of page one of my Student Aid Reports with this form.
____ I have sent in my Federal Student Aid Application and will forward a copy of page one of my Student Aid
Report as soon as I receive it.
Please send this completed form to: Personnel, Camp Berea, 68 Berea Road, Hebron, NH 03241
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