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Campership Application

The financial assistance application must be filled out completely. The initial campership application deadline is April 1, with notice of initial awards sent by April 15. Applications submitted after April 1 will be reviewed after the first and third weeks of the month with notification going out the following week. Decisions are made strictly on the basis of financial situation and council funds. A limited amount of financial assistance is available. Applications remain confidential. Each family is expected to pay a portion of the fees, including the $50 deposit required at time of registration.

COST OF CAMP: AMOUNT GIRL CAN PAY: AMOUNT OF COOKIE DOUGH AMOUNT FAMILY CAN PAY:

$ __________ $ __________ $ __________ $ __________

AMOUNT REQUESTED:

$ __________

(Line 1 minus Lines 2, 3, 4)

Missing or incomplete information will delay your request.

Camper’s Name: _______________________________________________________________________________________________________ Adult Contact Person’s Name: _______________________________________________________________________________________ Address: ________________________________________________________________________________________________________________ Street City State Zip

Home Phone: (_______)_____________________ Contact’s e-mail address : _____________________________________________ Grade (Fall 2013): _____________________ # of children in family: _____________________ Ages: _______________________ Girl lives with: ______ both parents ______ mother ______ father ______other __________________________________________ Mother employed: ____yes ____no

Father employed: ____yes ____no

Total Household Income: ____Under $15,000

____$15,001-$30,000 ____ $30,001-60,000

____$60,001-$80,000

____ over $80,000

Level: ____Non Girl Scout ____Ages 6-8 ____Ages 9-10 ____Ages 11-12 ____Ages 13-14 ____Ages 15-17 # years in Girl Scouting :_______ Session Date: _______________ Session Choice: __________________________________ Camp: ____________________________________________________________________________________________________________________ COMPLETE THE FOLLOWING QUESTIONS: All questions must be completed. Attach additional pages if necessary. 1. Describe specific reasons or circumstances for requesting campership funds. _________________________________ _____________________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________________ 2. Did your daughter participate in the 2012-13 Girl Scout Fall Product and Cookie Programs? If no, why not? _____________________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________________ 3. If your daughter earned Cookie Dough/S’more Dough and you are not applying it to camp, why not? _________ _____________________________________________________________________________________________________________________________ 4. What do you hope your camper learns from this experience? ____________________________________________________ _____________________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________________ Parent/Guardian Signature: ________________________________________________________ Date: __________________________ Please submit application with $50 deposit and registration form to GSNI, Elgin Service Center, 12N124 Coombs Rd., Elgin, IL 60124 OFFICE USE ONLY Amount Paid $ _____________________________ Campership $ __________________________ Date _________________________

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2013 GSNI Camp Program  

2013 GSNI Camp Program

2013 GSNI Camp Program  

2013 GSNI Camp Program

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