General InfoFinancial InfoOtherCAMPER INFORMATION Parent/Legal Guardian * Parent/Legal Guardian 2* Address City State / Province / Region Postal / Zip Code Country ---United StatesCanadaMexicoUnited Kingdom-----AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArmeniaArubaAustraliaAustriaAzerbaijanAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaireBosnia and HerzegovinaBotswanaBouvet Island (Bouvetoya)BrazilBritish Indian Ocean Territory (Chagos Archipelago)British Virgin IslandsBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongoCook IslandsCosta RicaCote d'IvoireCroatiaCubaCuraçaoCyprusCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly See (Vatican City State)HondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKazakhstanKenyaKiribatiKoreaKoreaKuwaitKyrgyz RepublicLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyan Arab JamahiriyaLiechtensteinLithuaniaLuxembourgMacaoMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunionRomaniaRussian FederationRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Netherlands)Slovakia (Slovak Republic)SloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia & S. Sandwich IslandsSpainSri LankaSudanSurinameSvalbard & Jan Mayen IslandsSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkeyTurkmenistanTurks and Caicos IslandsTuvaluU.S. Virgin IslandsU.S. Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUruguayUzbekistanVanuatuVenezuelaVietnamWallis and FutunaWestern SaharaYemenZambiaZimbabwe Phone Number* Parent/Guardian Email* CAMPER INFORMATION Please enter the information about your youth camper. Your First Name Your Last Name Camper Age (at time of camp)Youth must be 8 years old or going into second grade to be able to be put into a camper dorm. Only staff children are allowed under this age range and they will be housed with their parent(s). ---<11234567891011121314151617 Sex MaleFemale Next FINANCIAL INFORMATION (TO BE COMPLETED BY PARENT/GUARDIAN) In order for us to assess your financial need, please provide us with as much information as possible. Which camp would you like a scholarship for? Overnight Camp (July 16-20, 2019)Day Camp (August 21-23, 2019)Both Camps Total amount you can pay towards tuition for this camper: * Minimum payment amount is $25.00 for the camper application fee (collected when you submit your application). If you want to pay with a check, continue and fill out this application. At then end, when it asks you for a credit card payment, simply stop at that point. $ Dollars . Cents Amount you requesting from the SEP Montana general scholarship fund for this camper? *If you are registering and requesting scholarships for multiple campers, provide information on this form for this specific camper only. $Dollars . Cents Annual family income: * Select a family income range0-$12,500$12,500 – 25,000$25,000 – 37,500$37,500- 50,000$50,000 – 62,500$62,500 – 75,000$75,000 - 87,500$87,500-100,000over $100,000 How many family members in your household? * Select # of household family members123456789101112 Are there any other youth attending this camp from your household this year? * Yes - additional family members at camp this yearNo - additional family members at camp this year If other campers attending camp this year, what are their names? Have you received a scholarship in the past to attend SEP Montana? * YesNo Would you (parents) be able to help as a volunteer before/after or at camp? * YesNo Which service event can you participate in? March 27 - Fundraising Dinner : 6:00-8:00PMApril 9 - Pizza Ranch Fundraiser : 4:30-9:00PMMarch ?? - Statewide Phone Book DeliveryOvernight Camp Staff Member (July 11-19)Overnight Camp Setup (July 11-13)Overnight Camp Tear Down (July 19)Day Camp Staff Member (Aug 10-15)Other (comment below) BackNext - Other Info OTHER INFORMATION Why do you want to be attend SEP Montana Youth Camps? (To be answered by perspective camper in 1-2 sentences.)(required)(To be filled out by the camper - 1 or 2 sentences.) Parent/Guardian Endorsement: (To be answered by parent/guardian in 1-2 sentences.)(TO BE COMPLETED BY PARENT/GUARDIAN) This section must be completed in order for this scholarship to be considered. Please briefly provide information to the scholarship committee explaining why your child is in need of financial assistance to attend camp. Additional Comments / Suggestiions You will still need to complete a camper application form to complete your childs application. You may do this immediately after the scholarship application, or you may wait for scholarship approval before submitting your camper application.