Student Name(Required) First Middle Last Parent/Guardian Name(Required) First Last Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email(Required) You will be notified via e-mail if a scholarship is granted.Phone(Required)Age(Required)Please enter a number from 10 to 18.Gender(Required) Male Female If you are putting in for a female student, we currently have a waiting list for females. Waiting list will be first come first serve priority. By filling out form, you will automatically be put on waiting list for female students.School(Required) Have you attended Camp Freedom before?(Required) Yes No How many other children in the household will attend Camp Freedom this year?(Required)Amount You Are Able to Cover(Required) Total Household Monthly Income(Required) Please include all sources of income in this total.Please share a short explanation about why are you applying for a Camp Freedom scholarship?(Required) Δ
