Financial Assistance Application Please complete all of the questions. Attach additional pages if necessary. Completed applications must be submitted by June 7th, 2015. Note: Incomplete and late applications will not be considered by the Scholarship Committee. Step 1 of 3 33% Family InformationHow many campers will be applying for a scholarship?*OneTwoThreeName* First Last Name* First Last Name* First Last Parent/Guardian Name* First Last Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Home/Cell Phone*Parent/Guardian #2* First Last Address (if different) Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Parent Marital Status?* Married Single Divorced Widowed Please list the name and ages of any dependents, or children 18 years of age and younger, and/or children or other relative(s) receiving support from your parent(s)* Church LifeHome Parish* Parish Priest:* Are you a current steward of the above parish?* Yes No If any, what organizations within your church are you involved*Financial InformationParent/Guardian #1 First Last Occupation* Employer* Parent/Guardian #2 First Last Occupation* Employer* Parent/Guardian(s) Gross Annual Income: Please provide total annual gross incomes for 2015-2016 (estimate if necessary for 2016). Please note that this section must be complete.*2015: $2014: $ Essay (optional)If you wish, please elaborate, in 250 words or less, as why you want your child to attend St. Demetrios Camp this summer, and how the financial assistance will help you and your family. FINANCIAL ASSISTANCE APPLICATION AUTHORIZATION AND CERTIFICATIONWhile I understand all information will be kept strictly confidential, I authorize St. Demetrios Greek Orthodox Church to release application information, including copies of my application and attached files, to the St. Demetrios Greek Orthodox Church Scholarship Fund (SDGOCSF) or agent thereof. I agree to have St. Demetrios Greek Orthodox Church and/or the St. Demetrios Scholarship Fund Committee or agent thereof to verify any and all of the application information given, including pertinent personal and financial information. I also understand that I may be required to authenticate the information given by possibly submitting copies of additional financial records, or any other relevant document(s) or statement(s). I hereby certify that the information provided in this application is accurate and that I am the author of the application and its contents. I understand that if any information is found to be inaccurate or incomplete, the St. Demetrios Greek Orthodox Church Scholarship Fund will deny me an award. Agreement* I/we agree to the above authorization and certification. NameThis field is for validation purposes and should be left unchanged. Δ
