Friends of Indiana Youth, Inc.

 

The Friends of Indiana Youth, Inc. Board of Trustees has established scholarship funds for the purpose of providing financial assistance to those who would not be able to attend one of the Midwest summer camps for financial reasons.  Many generous people have donated money to help assist these campers.  We ask that you fill out these questions to help this Board make good decisions about support and be good stewards of this money.

B

†††  If you need assistance with this form or if you would like to help sponsor a camper, please contact us via the website www.midwestsummercamp.com   †††

 

Basic Information

 

Please print & fill in all sections as completely as possible

 

Child Requesting Scholarship __Janie _____________________________Doe____________________

First Name                                                              Last Name

 

Child's Age _14___     Male _____       Female __X__

 

 

Parent / Guardian (1) Name ___John____________________________Doe________________________

First Name                                                              Last Name

 

Address___123 Peaceful Ave____________________Fairview_____________Any___xxxxx_

Street                                                                                                      City                                          State        Zip

 

Parent / Guardian (2) Name___John_________________________Doe____________________________

First Name                                                              Last Name

 

Address_________________Same______________________________________________________

Street                                                                                                      City                                          State        Zip

 

 

Total # Family Members in Household ___5_              # of Children __3____  Married __X__ Single _____

 

For which camp are you requesting assistance?         Senior__ X __             Junior______

 

Have you ever attended either camp before?             Yes__ X ___                No_______

 

Have you ever received assistance before?                Yes______                    No___ X ____

 

 

Financial Information

 

Financial Assistance is generally granted for a portion of the total fee.

Each applicant will be expected to contribute towards their costs to the extent of their ability.

 

Total cost of camp:                                                                                          _______ $220___________

 

Deposit amount sent with registration:                                                            ________$50____________

 

Maximum amount you will be able to share in cost, if any, after deposit:      ________$50____________

 

Please describe the reason(s) why you are requesting financial assistance…

 

 

______I am writing to request assistance with my daughter's camp fees. My_________

 

______husband was involved in a car accident and has been unable to work.________

 

_____ I am in school, and we are receiving $128 per month in assistance. I work___

 

_____ odd jobs cleaning houses and babysitting.  We are on Medicaid and disability__

 

_____ but plan on my husband getting back to work soon. I can provide any__________

 

_____ documentation you require to verify the information I have given you. We_____

 

_____ worship at church of Christ in Anytown, Somestate, where John Smith is the_

 

_____ preacher. He would be willing to speak with you if you would like. Janie _____

 

_____ has gone to camp for the past six years and is eager to go again. Once my __

 

_____ is able to get back to his job, we will be able to pay the fees on our own. ___

 

____ Please let me know if you have any questions. Thank you for your ___________

 

____ consideration._____________________________________________________________________

 

____ John and Jane Doe________________________________________________________________

 

____000-123-4567______________________________________________________________________

 

___________________________________________________________________________________

 

__________________________________________________________________________________________

 

__________________________________________________________________________________________

 

__________________________________________________________________________________________

 

___________________________________________________________________________________

 

__________________________________________________________________________________________

 

__________________________________________________________________________________________

 

__________________________________________________________________________________________

 

___________________________________________________________________________________

 

__________________________________________________________________________________________