Campership Application 2020

1. Family Information

Before completing this application please go to http://www.childcarenj.gov/Parents/Calculator
to calculate your eligibility for the NJCK subsidy program. If your family qualifies for the NJCK subsidy please apply to the Office of Children. If not apply for Campership below.

Question Title

* 1. Name of Parent(s)/ Guardian

Question Title

* 2. Home Address

Question Title

* 3. City, State, Zip

Question Title

* 4. Best Phone

Question Title

* 5. email address

Question Title

* 6. Ethnicity (for statistical purposes only)

Caucasian/White

African American/Black

Latino/Hispanic

Asian

Other (please specify)

Question Title

* 7. Please list all children in the family, indicate male or female, and age and indicate if you are applying for campership for that child.

Child 1

Child 2

Child 3

Child 4

Child 5

Child 6

Question Title

* 8. Total family size (include self)

Question Title

* 9. Please describe any special needs or circumstances that help explain your need for a scholarship.

Question Title

* 10. Parent(s)/Guardian Employer

Question Title

* 11. Employer Address

Question Title

* 12. Family Monthly Income

Question Title

* 13. Bergen Campership Fund uses photos of children on its website and in its annual report; we don not ever use the names of children or families.

Yes, the Campership Fund has permission to use my child's/children's picture

No, please do not use pictures of my child/children

Question Title

* 14. Parent Signature (if completing online, please type name)

Question Title

* 15. Please indicate the date you completed this application

Date / Time

Date