HAWS Camp Scholarship Application

How many adults are in the home?

How many children are in the home?

How many children are in need of a scholarship?

Gross annual income of household

I certify the above information is accurate.

Parent Name

First

Last

Child Name

First

Last

Child Name

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Preferred method of contact

Camp name and date requested

Please note which specific camp and which week of camp you would like to attend.

Date