Summer Camp Scholarship application
If you are in need of financial assistance to cover the cost of ChiArts Summer Camp, please fill out this form separately for each child you would like to enroll.  

Fill this out prior to registering for camp.  We will evaluate your info and send you a coupon code through email to use for the registration and payment.  

Please reach out to us about anything at summercamp@chiartsfoundation.org, or text us at (872)222-8114.  

Spanish language assistance / En español:  Si Ud require ayuda para llenar este formulario, por favor envía un mensaje de texto al número (872)222-8114 para pedir ayuda, y le volveremos a llamar para completar este formulario.  
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Parent contact info
Your first name *
Example:  Laura
Your last name *
Example:  Smith
Relation to child *
Example:  Mother
E-mail *
Phone number *
Student address *
Example:  4152 W. Diversey Ave, Chicago IL 60639
Financial info
Please list all household income here, including all contributors *
Example:  35,000
Your employer and/or profession *
Example:  Northern Trust Company, administrative assistant
Spouse's employer and/or profession
Total number of dependents *
How many individuals, not including yourself, are financially dependent on you?  For example, 3 ( = 2 children, 1 stay-at-home spouse)
Are there special circumstances that affect income as it is reflected in your income? Please include student loans, familial support, unemployment, child support, etc. *
Student info
Child's name (last, first) *
Example:  Smith, Giovanni
Child's birthday *
MM
/
DD
/
YYYY
Student grade in Fall 2021 *
In other words, what grade will they enter next school year?
Tell us more about your child! What are their interests, hobbies, extracurriculars?  After school, weekend, and self-guided activities can be included. *
Any additional comments or questions?
Signature
Please click "Accept" on the statement below to verify that the information you have provided for us is factual.  
By submitting this application, I affirm that the facts set forth in it are true and complete. I understand that if I am accepted as a scholarship recipient, any false statements, omissions, or other misrepresentations made by me on this application may result in the revocation of financial assistance.   *
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