Frederick-Page 4-H Junior Camp

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June 16-20, 2024

Scholarship Form

Scholarship awards depend on donations received and are awarded on a first come, first serve basis. All scholarship requests are due to your extension office with other registration forms. Unit Extension staff will communicate your total amount due and payment deadline.

REMEMBER: REGISTRATION FORMS AND SCHOLARSHIP APPLICATIONS ARE DUE WITHIN 5 days TO HOLD YOUR SPOT AT 2024 CAMP. *Note* If awarded a scholarship, you must pay the $50 deposit via check or cash. Using a credit card is not accepted.

Email *

First Name of Camper or Counselor *

Last Name of Camper or Counselor
*

Mailing Address
*

City
*

State
*

Zip code
*

Date of Birth of Camper or Counselor
*

Age on September 30, 2023
*

Gender
*

Primary Phone Number *

Please list any 4-H activities that the camper or counselor is involved in.
*

With whom does the child reside?
*

Number of children in the household:
*

What school does the camper or counselor attend?
*

Has the child attended 4-H Camp before?
*

Yes

Has the child attended another camp before?
*

Yes, if yes where and how was attendance funded? (Who paid for it?)

Other:

Why is a scholarship being requested? Please tell us about your financial need for a scholarship and why the child would like to attend 4-H camp. All information will remain confidential.
*

What amount of scholarship are you requesting? Each family is asked to pay at least $50 toward lodging and food costs. Payment plans are also available. *

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