4-H Camp Scholarship Application

Please complete the following information and return to: Lisa Ortiz, 4-H Agent Cooperative Extension Service PO Box 389 Newton, NC 28658 Email: lortiz2@ncsu.edu Phone: 828-465-8248

Child’s Name: ______________________________________
Age: ______
Gender: M / F

Address:

Phone Number: _______________________
Email: _______________________________________

Parent/Guardian Names:

Mother’s Place of Employment and Position:

Father’s Place of Employment and Position:

Number of Family Members: _______

Has the child attended camp before? Yes / No
If yes, where and when? ___________________________________

Financial Need:
Amount the family can contribute toward camp cost: ___________
(Scholarship recipients are asked to contribute a portion.)

Why are you seeking a camp scholarship?
(Please explain any financial challenges or reasons you need assistance.)

Has your child participated in 4-H or other extracurricular activities?
(Please describe your child’s involvement.)

This information is true to the best of my knowledge.
Parent Signature: _________________________________

Additional Required Documents:

Letter of Recommendation: A letter from an adult who knows the child, explaining why the child should receive a scholarship.
Child's Personal Statement: A paragraph written by the child explaining why they want to attend camp.

Please note that incomplete applications will not be considered.

Application Deadline: March 1