2010 Scholarship Application Form

Camper's Name

Birth / /   Sex:    M F

Family's total 2009 Income $

Family's total Income Last Month $

Names & Ages of all Household Members:

Reason Requesting Aid (Be Specific):

1st Choice Camp Kiddie Camp Tenderfoot Camp Pioneer Camp Junior 1 Junior 2 Junior Wilderness Junior High 1 Junior High 2 Junior High Wilderness Junior High Canoe Caventure Camp Creative Arts Yough River Adv . Youth Camp CIT Camp Sr. High Canoe Camp Women's Camp

Camp Fee   $

Amount Family can pay $

Church/Agency Portion if Applicable $

Financial Aid being Requested $

Submitting this form means you have read the Scholarship Instructions printed at the top of this page, and that you will abide by CBD's policies, and their decision concerning your financial aid request.