CAMP SCHOLARSHIP FORM

PROGRAM INFORMATION

Name of program *

Total cost of program *

Requested scholarship amount from WIA *

If WIA could only provide a partial amount of your requested scholarship, would you be able to afford to participate in the program? *

WIA intends that our scholarships fund the gap, meaning that we'd like to provide support when other financial support options have been exhausted. Please indicate other resources you have applied for with regards to this scholarship request. *

What are you hoping your child will grain from this experience? *

HOUSEHOLD INFORMATION

Annual pre-tax income for the household (please give your best estimate, including both parents even if in separate households, unemployment benefits, alimony, child support, investments, rental property income, etc.) *

To be eligible to receive a scholarship WIA asks for proof of income. Please upload the two most recent paystubs for all earners in the household. *

Click or drag files to this area to upload. You can upload up to 6 files.

Number of adults in the household *

Number of children in the household *

Please give a short description of your household. (two parents in one household, parents in separate households and co-parenting, parents in separate households, one with sole custody, etc.) *

Please explain your need for financial assistance and provide any additional information that would be helpful in determining your eligibility. *

CHILD’S INFORMATION

Child's name *

First

Last

Child's age at start of the program *

Child’s gender *

Does your family live, work, or attend school in Big Sky? *

SURVEY & SIGNATURE

How did you hear about WIA's Scholarships? *

What do WIA scholarships mean to you and your family? *

I give permission for my anonymous quote to be used in media releases, written information, website postings, or brochures used to promote the work of WIA. *

Parent Email Address *

Parent Phone Number *

Please enter your full name to digitally sign this application. By signing you agree that all information is accurate, that this is information is being given for receipt of a WIA Scholarship, and that deliberate misrepresentation of the information will disqualify you immediately from this program. *

Date *

If you are in need of immediate mental health assistance, call 988 the 24/7 emergency line to speak with a crisis counselor at the Help Center in Bozeman.