Camp Kaleideum Scholarship Application Thank you for your interest in applying for a scholarship to Camp Kaleideum. Please be as accurate and detailed as possible in this form. Scholarships can be used for one (1) free week of camp. Please fill out the form for each camper you are requesting a scholarship for in this application. Contact Lindsay Douglas at email@example.com with any questions you may have regarding scholarships. Parent/Guardian ContactYour Name* First Last Email* Phone*Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Are you a Member of Kaleideum?*YesNoScholarship QuestionsWhat grade(s) will your camper(s) be rising to this fall?*Which camp location do you prefer?*Kaleideum NorthKaleideum DowntownNo preferenceDoes your family receive any aid listed below?* SNAP WIC TANF Other None Include the name(s) of aid your family receives that is not included in the above question*Do any of your children receive the following aid at school?* Free Lunch Reduced Lunch Preschool Subsidy Other None Name the other type(s) of aid your child(ren) receive(s) at school*What is your total monthly household income?*How many adults are living in the household?*Please enter a number greater than or equal to 1.How many children are living in the household?*Please enter a number greater than or equal to 1.Have you received a scholarship for Kaleideum Summer Camp in the past?*YesNoWere you referred to our Scholarship Program through an organization, shelter, social worker, or other service provider?*YesNoPlease provide the name of the organization or social worker*How did you hear about our Scholarship Program?* kaleideum.org Search Engine From a Kaleideum Staff Member Word of Mouth Other Supplementary QuestionsPlease tell us a little about your family's financial situation.If you received this scholarship, in what ways would it affect your family?What will your camper gain from experiencing Camp Kaleideum?General Release* I understand that this application does not secure a space at Camp Kaleideum and that any scholarship awarded will be sent via separate email. I understand that cancellations must be made at least two weeks in advance of my camp start date. If I cancel within two weeks, I may not be able to apply for a scholarship next year.