Scholarships - Retreat Season

Scholarship Application Form

Our goal is to provide assistance to those who are prevented, because of financial hardship and the limited resources or absence of a local "home church", to attend summer camp at Lake Ann Camp. It is our desire that no child miss out on a Lake Ann Camp experience because of financial circumstances. Limited funding is made possible by the generosity of donors and the Red Canoe. Unfortunately, we cannot guarantee that every request will be granted, so please submit your application as soon as possible. Our Scholarships Coordinator will contact you by phone or e-mail once your request has been reviewed.

Camper Name*
First Last
Parent/Guardian Name*
First Last
Address*
Address Line 1 Address Line 2 City State / Province / Region ZIP / Postal Code
Phone*
Email*
Home Church Name*

If you don't currently attend a church, please put "none"
Church City & State*

If you don't currently attend a church, please put "N/A"
Church Phone Number
Please select one of the following*
- I've asked my church to help scholarship my camper(s) and they have agreed to provide financial assistance.
- I've asked my church to help scholarship my camper(s) and they are unable to provide financial assistance
- N/A, I do not attend a church
If your church is providing assistance, how much?
Week & program requested*
Payment you can afford*
Yearly income (from all sources)*
Number of people in your household*
Please enter a number from 1 to 20.
Number of children attending camp*
Please enter a number from 1 to 20.
Scholarship amount requested*
Please tell us about any extenuating circumstances related to your financial need which will have contributed to your need for a scholarship*
Signature*
Date
MM slash DD slash YYYY