Camp Sweeney
Serving Children with Diabetes for More than 70 Years
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Camper Special Aid Request Form
2023
Summer - First Session
Starts In
SPECIAL AID REQUEST FORM
Camper Information
Camper Name
*
First
Middle
Last
Suffix
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
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
State County (not country)
*
International Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Country
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
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 is Parent
Guardian is Adoptive Parent
Guardian is Step Parent
Guardian is Foster Parent
Guardian is Grandparent
Guardian is Aunt or Uncle
Guardian is Sibling
Guardian is a Case Worker
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 is Parent
Guardian is Adoptive Parent
Guardian is Step Parent
Guardian is Foster Parent
Guardian is Grandparent
Guardian is Aunt or Uncle
Guardian is Sibling
Guardian is a Case Worker
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
2023 SESSION DATES:
Session 1:
June 4 - June 22
Session 2:
June 25 - July 13
Session 3:
July 16 - August 3
Cost per session: $4,000.00
Has Camper attended Camp Sweeney before?
*
Yes
No
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 2022 tax return, 2022 Form 1099(s), 2022 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 1/31/2023, please use
2021
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 2022 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
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
No
Was Special Aid granted?
*
Yes
No
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
Select files
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
No
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.).
This request form does NOT guarantee special aid or enrollment in camp.
Special aid applications will be considered periodically by Committee starting in December. Please check with the Camp Registrar for deadline dates.
CAMPER WILL NOT BE ENROLLED until deposit (full $500 or reduced per Committee) is paid and an enrollment application is submitted. This special aid form is not an enrollment application.
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