Tuition Assistance Form

Date

MM slash DD slash YYYY
Camper's Name*

First

Last
Camper's Date of Birth*

MM slash DD slash YYYY
Which camp are you interested in attending?*
Which session are you interested to attend in New Hampshire?*
Which session are you interested to attend in Maine?*
Number of siblings ages 18 and under living at home.*
Your Name*

First

Last
Email*
Father's/Guardian's Occupation*
Mother's/Guardian's Occupation*
Home Phone
Cell Phone
Address*

Street Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Country
Amount of scholarship requested*

Please indicate the dollar amount that you are requesting off full tuition.
Annual Gross Family Income*

From line 1a on Federal Tax Return
Taxable Income

From line 15 on Federal Tax Return
Have you contacted your home church for assistance?*
- Yes
- No
Would you be willing to help us out at camp during our Fall and Spring Work Weekends? This is a FREE event but it is an opportunity to "give-back" to camp with some time and energy as we maintain the properties.*
- Yes
- No
Please provide an explanation of the extent of need for financial aid, why attendance at Brookwoods, Deer Run, or Moose River Outpost is desired, and any other remarks that would be useful in determining an award:*

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