2020 Scholarship/Financial Assistance Application (for SpringHill Day Camp at Heritage Church)

Please answer questions fully and in their entirety. Incomplete applications will not be considered.

Submitting this application does not guarantee you will receive a scholarship and/or financial assistance. Scholarships/assistance is needs-based and subject to availability. Answers are kept confidential and only reviewed by those who will make the final determination of scholarships/assistance provided.

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* Parent/Guardian Information

Full Name

Address

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* How often do you attend Heritage Church?

Weekly

A Couple Times a Month

Every So Often

I Do Not Attend Heritage Church

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* If you attend Heritage, which campus do you attend?

Bettendorf

Rock Island

Vida Nueva

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* What areas of ministry are you involved with at Heritage?

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* What is your gross household income?

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* Do you receive any government aid? If so, please describe what you receive.

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* Parent/Guardian Work History

Current Employer:

Employer's Address/Phone:

How many hours a week do you work?

How long have you been working there?

Previous Employer/Length of Employment:

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* Spouse (or Other Adults Who Provide Financial Support to Household) Information. If you are a single income family, please skip this question.

Name:

Phone:

Relationship:

Current Employer:

Employer's Address/Phone:

Total Monthly Income:

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* How many people are in your household?

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* Child(ren)'s Information

Child's Name:

Date of Birth:

Child's Name:

Date of Birth:

Child's Name:

Date of Birth:

Child's Name:

Date of Birth:

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* Have you filled out a request for scholarship aid from SpringHill?

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* Can you contribute any amount to SpringHill fees? If so, how much?

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* Would you be interested in a payment plan through SpringHill?

Yes

Maybe

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* Please explain why you would like to be considered for financial assistance; including any special circumstances. (Medical bills, illness, unemployment)