* 1. Please enter your first and last name

* 2. What is your camper's name?

* 3. What is your camper's birthdate (DD/MM/YYYY) and diagnosis?

* 4. How many members in your family?

* 5. Annual earned income for the family? (est.)

* 6. What therapies does your camper currently participate in?

* 7. Please give a brief explanation on your need for this scholarship. (Be as specific as possible- all comments are confidential)

* 8. If you are granted one of our partial scholarships, do you understand that you are responsible for the remaining tuition?

* 9. Do you understand that a refundable deposit of $200 must be submitted with a camper registration in order for us to consider your scholarship application?

* 10. If there is anything you would like our scholarship committee to know, then please comment below.

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