Supporting Children with Diabetes for 75 Years

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Camper Special Aid Request Form

2024 Summer - Third Session

Starts In

SPECIAL AID REQUEST FORM

"*" indicates required fields

Camper Information

Camper Name*

First Middle Last

Name the CAMPER prefers to be called*

First

Camper Sex*

Required for cabin assignment.

Male

Female

Camper Date of Birth*

MM slash DD slash YYYY

Do you live within the United States?*

Yes

No the camper lives in another country

Mailing Address*

Street Address City State ZIP Code

State County (not country)*

International Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Guardian 1 Information

Guardian 1 will be listed in the camper's file. By providing this information, you are giving permission to release camper information to Guardian 1.

Guardian 1 Name*

First Last

Guardian 1 Relationship to Camper*

Guardian 1 Occupation*

Guardian 1 Employer*

Guardian 1 Email*

Guardian 1 Phone*

Cell

Home

Work

Guardian 1 Phone Number*

Guardian 2 Information

Guardian 2 will be listed in the camper's file. By providing this information, you are giving permission to release camper information to Guardian 2.

Guardian 2 Name

First Last

Guardian 2 Relationship to Camper

Guardian 2 Occupation

Guardian 2 Employer

Guardian 2 Email

Guardian 2 Phone

Cell

Home

Work

Guardian 2 Phone Number

Doctor Information

Camper's Diabetes Doctor (Endo)*

Session Information

2024 SESSION DATES:
Session 1: June 2 - June 20
Session 2: June 23 - July 11
Session 3: July 14 - August 1

Cost per session: $4,500.00

Has Camper attended Camp Sweeney before?*

Yes

Which session does the camper want to attend?*

First Session

Second Session

Third Session

Standard and Special Financial Aid

Please enter the annual income from each of these sources. Enter 0 If no income is received from that particular source. Proof of income is required.

DOCUMENTATION OF INCOME REQUIRED:
1. Earnings/Wages: First and second pages of 2023 tax return, 2023 Form 1099(s), 2023 W-2(s) from each employer, or 2 most recent paycheck stubs from each worker or current unemployment paystub. If application is made prior to 1/31/2024, please use 2022 tax return, 1099, or W4 if a current paycheck stub is not available.
2. If you are self-employed, own your own business, and have NOT filed taxes yet, you may send a current Profit and Loss Statement.
3. Child Support/Alimony: Court order papers.
4. Social Security/Retirement: Letter from US government or 2023 retirement income tax document.
5. Government Support: Letter from US government. Example: TANF, food stamps, etc.

1. Annual Earnings/wages from work before deduction*

2. Annual Net Income from SELF-EMPLOYMENT*

3. Annual Child Support and/or Alimony Income*

4. Annual Social security, disability, or other retirement income*

5. Annual Other government support*

Number of people living in the household?*

Include camper, parents, siblings, and any other person(s) living in the household even if not related biologically.

People living in household*

Please tap/click the + icon to add additional names.

Name

Age

Relationship to Camper

With whom does the child live?*

Both parents

Father

Mother

Grandparents (without parents)

Foster parents - Please send letter from case worker

Other

If your income is $0, how do you pay for food, housing, and other living expenses?*

Have you ever applied for Special Aid before?*

Yes

Was Special Aid granted?*

Yes

Tell us why you need Special Aid for the coming summer.*

Be specific. Are there any unusual family expenses? Is your child newly diagnosed? Are there any other family members with a chronic illness? Has there been any loss of income in the last year (when & how much)? Any other reason?

FINANCIAL AID Documentation Upload (up to 10 files, max file size 1.95MB). If file exceeds limit, please email to Registrar@CampSweeney.org

Drop files here or

Max. file size: 195 MB, Max. files: 10.

OTHER SPONSORS: Have you applied for or received a scholarship from any other source for this session? (i.e. Bacon Bash, a church, or service organization)*

Amount of special aid awarded cannot exceed the remaining tuition balance after payments and other sponsorships have been applied to your account.

Yes

Other sponsor source:*

Please list the name of other source, the amount of sponsorship, and the process to get the sponsor funding to Camp Sweeney (when will they decide, your source contact info, etc.).