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Scholarships are made available thanks to the generosity of:  The Campfire Foundation & The Papoose Club 

Scholarship Application Summer 2014 Financial assistance is awarded based on applicant’s demonstrated need and available funds. To help determine the need of each family, we require the parents to complete the following confidential form and return it to the ERC. Applications are considered on a continual basis for as long as funds are available, beginning in early May – apply early! Please fill out separate application for each child that you are requesting scholarship funds. Are you filling out more than one application? Yes No Student(s) Name: _______________________________________________________________________ Which EcoCamp(s) are you requesting scholarship funding for: __ EcoCamp Day Camp- Lift Off: The Science of Flight June 16-19(20) __ EcoCamp Day Camp- Secrets of Underwater Life July 7-10(11) __ EcoCamp Day Camp- Night Stalkers, Day Risers August 11-14 (15) __ EcoCamp Environmental Outdoor Leadership Overnight Camp: Mountain Survival July 28-August 1 __EcoCamp Environmental Outdoor Leadership Overnight Camp: Sense of Place: Discovering Our Alpine Ecosystem August 4-8 Please return this application by mail, e-mail, or in person as soon as possible. Please note that completing this form does not register your child in camp; you must complete a registration form and make a $50 deposit. The more information you provide, the easier it will be for the scholarship committee to make an informed decision. This application is confidential and information will not be shared with anyone else. Questions? Please call 208.726.4333 or e-mail: allison@ercsv.org Please send this completed form to: Environmental Resource Center c/o Allison Marks P.O. Box 819 471 N. Washington Avenue Ketchum, ID 83340 208.726.4333 If submitting electronically send to: lhorton@ercsv.org Did you include (or already send): The Program Registration Form

Yes

$50 registration deposit per student

No

Yes

No


*Deposit will be refunded if we cannot provide enough financial aid*

GENERAL INFORMATION Camper’s Name(s)_______________________________________________________________ Camper’s Date of Birth ___/___/___ 2nd Camper’s Date of Birth ___/___/___ 1) Parent/Guardian ____________________________________________________________ Address ______________________________________________________________________ City _____________________________________________ State ______ ZIP _____________ Telephone (day) ________________________ (evening) ______________________________ E-mail _______________________________________________________________________ Occupation ___________________________________________________________________

2) Parent/Guardian ____________________________________________________________ Address ______________________________________________________________________ City _____________________________________________ State ______ ZIP _____________ Telephone (day) ________________________ (evening) ______________________________ E-mail _______________________________________________________________________ Occupation ___________________________________________________________________

Were you referred by anyone? If so, by whom ______________________________________


FINANCIAL INFORMATION Number of children in family that you claim as dependents ___________________________ Taxable household income from last year’s tax form _________________________________ Other sources of income (alimony, friends/relatives) _________________________________ This application reflects financial information for the household of: ________________________

Does your family participate in the following programs? Free/reduced lunch Yes No Food stamps Yes No State Cash Assistance Yes No Foster child Yes No Other:

Have you previously received financial aid for EcoCamp? If yes, what year(s)? _________________

Yes

No

The ERC may not be able to award financial aid for the full cost of a camp session. What would be the most you can contribute to allow your child to attend camp? $_____________

I / We, the undersigned, affirm the above information is true. (1) Parent/Guardian: ____________________________________ Date: ______________ (2) Parent/Guardian: ____________________________________ Date: ______________

Please explain any extenuating circumstances you would like the Financial Assistance Committee to consider (attach additional page if necessary):


Ecocamp scholarship application form 2014