Reading Moravian Church Scholarship Request

Personal Information (To be completed by applicant)

Name (First, M I, Last)

Date of Birth

Address

City

State

Zip

Church Member

Prior Scholarship Awards?

Prior Camp Awards?

Telephone Number

Yes

No

Youth

No

Yes
Amount:

No

Yes
Amount:

(    )-

Higher Educational School/Program (To be completed by applicant)

Telephone Number

Name

(    )-

Address

City

State

Zip

Parent's / Sponsor's Information (To be completed by applicant)

Telephone Number

Name

(    )-

Camp Hope, Hope NJ (To be completed by applicant)

Enrollment Date

Enrollment Cost

Board of Trustees Information (To be completed by Board)

Program

Qualified (yes or no)

Amount Awarded

Date Approved

School Scholarship

Camp Hope

Signature, President, Board of Trustees:

F-0001 rev web

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