Northeast Illinois Council, BSA 2745 Skokie Valley Road Highland Park, IL 60035 Camping & Program Assistant: Debi Geiger Email completed form to: [email protected] Direct Line: 847-748-9161 or Fax completed form to: 847-433-2036 2016 CUB SUMMER PROGRAM SCHOLARSHIP APPLICATION The purpose of the scholarship program is to assist Scout families who need help meeting the financial requirement for these Northeast Illinois Council sponsored or supported outdoor summer experiences. Up to 50% of the Scout’s camp fee may be requested (only in extreme circumstances will assistance of more than 50% be granted). Every effort will be made to honor the request received, but please note that the total amount given will be based on need and funds available to this program. We encourage scouts to participate in fundraising to earn money for camp. The completed Scholarship Application must be in the council office (or faxed/emailed to Debi) by April 22, 2016. Contact Debi if your Scout joined his Cub Scout Pack after this deadline. Day Camp & Twilight Camp: We will inform the Scout’s parent and necessary Adult Leader by May 10, 2016 (if turned in by deadline), of the amount that will be applied as a scholarship credit toward the Scout’s online registration fees, and the balance amount still due (no late fees will be incurred). Indian Mound Camps: We will notify the Scout’s parent, necessary Adult Leader, and Three Harbors Council of your approved scholarship amount. NOTE: Scholarships for these 2 camps are for Northeast Illinois Council Scouts only. Families from other councils must contact Three Harbors Council regarding financial assistance for these 2 summer camp programs. Page One to be filled out by the (or family representative) – 1 Scout & 1 Event/Week per form, please:

District (circle 1): Aptakisic North Star Potawatomi OR Out-of-Council: Council Name ______

Scout’s First and Last Name______Unit & # ______

Street Address______Current Grade______

City, State, Zip Code ______

Program (Circle 1): Cub Scout Family @ Indian Mound (Fee-$65, early bird-$60) Twilight Camp (Fee-$65)

Day Camp #1 (Fee-$65) Day Camp #2 (Fee-$65) Day Camp #3 (Fee-$100) Day Camp #4 (Fee-$100)

* Make arrangements to get these fees to the Northeast Illinois Council office. Extent on Scholarship Needed (Round all amounts to the nearest dollar)

Cost for 1 Event/1 Week (above fees only, not “extra” costs to your family) (A) $ ______

Amount of funds your family will be able to pay (1) $ ______

Amount from your Scout’s “Pack Account” being used toward this fee (2) $ ______

Amount the Unit or a private sponsor will contribute toward this fee (if any)* (3) $______

Write the total amount of funds available here (1+2+3 = B) (B) $ ______

Write the amount of the scholarship requested (A-B = C or cost-funds=scholarship) (C) $ ______

Parent or Guardian’s Name (PLEASE PRINT CLEARLY): ______

Parent or Guardian’s Daytime Phone ______Email ______

Parent or Guardian’s Signature ______Date Signed ______Page Two to be filled out by Pack or Den Leader (or Pack representative):

Based on your knowledge of the Scout and his family, please list reasons why you think this scholarship should be awarded (Examples: attends meetings on a regular basis; actively participates in scouting activities – give details):

Has this scout demonstrated initiative to earn money on his own to help pay for any of his scouting activities? If yes, please explain.

Adult Leader Name (PLEASE PRINT CLEARLY) ______

Adult Leader Signature ______Date ______

Adult Leader Position ______

E-mail Address ______

Daytime Phone ______Home Phone (if different) ______

FOR OFFICE USE ONLY AMOUNT APPROVED: $ ______CAMP CODE ______

Day Camp Twilight Camp Family Camp @ Indian Mound Resident Camp @ Indian Mound

COUNCIL APPROVAL BY: ______DATE: ____/_____/_____