2019 Scholarship Application Please keep the following in mind as you complete this form: To serve the maximum number of children, we generally award up to 50% of the cost of camp. Not everyone will receive this amount though, as all aid is awarded based upon household size and income level and is awarded on a first-come, first-served basis until our funds are depleted. All information is confidential. Please fully complete this form and upload all requested documentation. We ask every family to contribute something to their child(ren)’s camp. Please list the largest amount you feel you can contribute, so we can make the best use of our resources and bring more kids to camp. Application reviews take place in the order they were received. We will notify you as soon as a decision is made. We can make arrangements for payment provided that the final payment is received prior to your child(ren) attending camp. IMPORTANT NOTE: In the event we can offer aid and you accept it, we will send you a confirmation email along with an online link to complete the remaining camp forms. Upon completing the forms, you will be charged a camp deposit of $10/child. If you have questions, please contact Camp Staff at zieglerparkcamp@gmail.com Question Title * 1. Parent/Guardian Email Address Question Title * 2. Parent/ Guardian Name & Address Name Address Address 2 City/Town State/Province -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP/Postal Code Question Title * 3. Child(ren) Name(s)If you are requesting assistance for more than 5 children, please email zieglerparkcamp@gmail.com Child #1 Child #2 Child #3 Child #4 Child #5 Question Title * 4. Please select the following that apply to your child(ren): My child(ren) has previously attended Ziegler Park Summer Camp My child(ren) has attended the Saturday Hoops program My child(ren) attends one of the following schools: Rothenberg Academy, Hays Porter, St. Francis Seraph, SCPA, or Taft Question Title * 5. Please indicate the size of your household: 2 3 4 5 6 7 8 8 or more Question Title * 6. Please indicate your total household income over 12 months: Under $24,360 Between $24,361 and $30,630 Between $30,631 and $36,900 Between $36,901 and $43,170 Between $43,171 and $49,440 Between $49,441 and $55,710 Between $55,711 and $61,980 Over $61,981 Income VerificationPlease provide support documents for ONE of the following options: Copy of prior year's tax return. Note: If you do not have a copy of your tax return, you may obtain one by contacting the Internal Revenue Service. Copy of your last two pay stubs. Copy of Social Security or Disability checks, or copy of bank statement showing amount of automatic monthly deposit. If you do not have these documents, you will not be able to complete a scholarship application. Question Title * 7. Attachment #1 Only PDF, DOC, DOCX, PNG, JPG, JPEG, GIF files are supported. DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only. Choose File Choose File No file chosen Remove File Only PDF, DOC, DOCX, PNG, JPG, JPEG, GIF files are supported. Question Title * 8. Attachment #2 (if needed) Only PDF, DOC, DOCX, PNG, JPG, JPEG, GIF files are supported. DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only. Choose File Choose File No file chosen Remove File Only PDF, DOC, DOCX, PNG, JPG, JPEG, GIF files are supported. Question Title * 9. What is the maximum dollar amount you can contribute to your child(ren)'s summer?This does not guarantee you will receive the amount you ask for, but is a guide for us. Question Title * 10. Please feel free to provide any additional information which you feel would help us make a decision on your scholarship application. Thank you. Done