2023 Summer Champ Camp Financial Assistance Form


*Address Line 1
Address Line 2
*City
*State/Province/Region
*Zip/Postal Code
To apply for a scholarship and register students for Summer Camp, this confidential form must first be completed. After the request has been reviewed, you will be notified and receive a code to use on the Camp Registration form. Please note that 100% scholarship is rarely provided. Questions? Contact Rob Henneberg at rhenneberg@4thpres.org or 301-320-1336.
Student name(s)
Camp cost at time of application
If you are requesting a scholarship for a specific amount, please list that amount below.
If you are requesting a payment extension, please list the schedule of payment below.
If you and your student would like to help in the Youth Office in return for a scholarship, please list availability below.
Please tell us anything else you would like us to know to help determine assistance.
*Parent Name:
*Parent Email:
*Parent Phone Number:
Submit Form