Scholarship Application Please enable JavaScript in your browser to complete this form.Household Info - Step 1 of 3How many campers are you applying for? *1 Camper2 Campers3 CampersCamper Name *FirstLastNicknameGender *AgeGradeBirthdate *MM123456789101112/DD12345678910111213141516171819202122232425262728293031/YYYY20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Camper Name 2 *FirstLastNickname 2Gender 2 *Age 2Grade 2Birthdate 3 *MM123456789101112/DD12345678910111213141516171819202122232425262728293031/YYYY20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Camper Name 3 *FirstLastNickname 3Gender 3 *Age 3Grade 3Birthdate 3 *MM123456789101112/DD12345678910111213141516171819202122232425262728293031/YYYY20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Parent/Guardian Name *FirstLastRelationship to Camper *Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone *Email *NextCo-Pay *Amount you and other family members can contribute towards the camp fees.Who is financially responsible for this camper? *Is this camper part of the foster care system? *YesNoTotal Household IncomeFinancial Documentation to accompany this form *Please provide TANF, SNAP, or FDPIR Case # OR if you do not receive state or federal financial assistance we will be contacting you for previous years tax returns.Number of Adults in Household *Number of children in household *PreviousNextSession for which your camper is applyingPlease Rank your Session five Smiles for you first choice one smile for your last choice. we recommend a 1 week session for 7-8 year-olds. Two weeks is the maximum time for which we offer scholarship funding.Session A *Rate 1 out of 6Rate 2 out of 6Rate 3 out of 6Rate 4 out of 6Rate 5 out of 6Rate 6 out of 6One Week: Monday, June 15th to Saturday, June 20th $1100Session B *Rate 1 out of 6Rate 2 out of 6Rate 3 out of 6Rate 4 out of 6Rate 5 out of 6Rate 6 out of 6Two Week: Monday, June 22nd to Saturday, July 4th $2200Session C 1 *Rate 1 out of 6Rate 2 out of 6Rate 3 out of 6Rate 4 out of 6Rate 5 out of 6Rate 6 out of 6One Week: Monday, July 6th to Saturday, July 11th $1100Session C 2 *Rate 1 out of 6Rate 2 out of 6Rate 3 out of 6Rate 4 out of 6Rate 5 out of 6Rate 6 out of 6One Week: Monday, July 13th to Saturday, July 18th $1100Session D *Rate 1 out of 6Rate 2 out of 6Rate 3 out of 6Rate 4 out of 6Rate 5 out of 6Rate 6 out of 6Two Week: Monday, July 20th to Saturday, August 1st $2200Session E *Rate 1 out of 6Rate 2 out of 6Rate 3 out of 6Rate 4 out of 6Rate 5 out of 6Rate 6 out of 6Two Week: Monday, August 3rd to Saturday, August 15th $2200Personal Statement *We require you to write a letter to the Screening committee describing your child, your families financial need, and why you think Camp Winnarainbow would be a good match for your Camper.Optional Additional Information (for community building and statistical purposesSelf Identified EthnicityIs this Camper associated with a homeless program?YesNoWhich Program?Is this Camper associated with any First Nations Tribes?YesNoWhich Tribe?Is this Camper associated with any Social Services Agency?YesNoWhich Agency?Does your Camper have a parent who is in prison?YesNoIs there anything else you would like us to know?CommentSubmit Application
