1. Family Information

STOP - Does your family qualify for NJCK subsidy funding? To apply go to https://www.childcarenj.gov/Parents/SubsidyProgram. NOT SURE? Call 1-800-332-9227 to find out.
IF YOU DO NOT QUALIFY for NJCK continue filling out the form.

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* 1. Have you applied first through the Bergen County Office for Children?

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* 2. Name of Parent(s)/ Guardian

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* 3. Home Address

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* 4. City, State, Zip

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* 5. Best Phone

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* 6. Email Address

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* 7. Ethnicity (for statistical purposes only)

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* 8. Please list all children in the family, indicate male or female,  and age and indicate if you are applying for campership for that child. Please note we only provide assistance to children aged 3 - 12 years old.

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* 9. Total family size (include self and any other adults living in the household)

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

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* 11. Parent(s)/Guardian Employer (Our program assists working families in Bergen County only, you must be working to receive scholarship)

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* 12. Employer Address

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* 13. Family Monthly Income (include all income)

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* 14. Are you an employee of Bergen County?

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* 15. 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.

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

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* 17. Please indicate the date you completed this application

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