Camper Scholarship Application Camper Scholarship Application Camper's Full Name*Age*PLEASE CHOOSE678910111213141516Sex*FemaleMaleSchool (2019-2020 school year)School Grade (2019-2020 school year)*Kindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade6th Grade7th Grade8th Grade9th Grade10th GradeParent 1 Full Name*Parent 2 Full NameHome Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Parent 1 Phone*Parent 2 PhoneParent 1 Email* Parent 2 Email Parent 1 Occupation*Parent 2 OccupationParent 1 Annual Gross Income*Parent 2 Annual Gross IncomeIn addition to your household income, does your family receive any additional financial support (ex. child support)? Additional Income*YesNoAdditional Income Amount per MonthIs Camper living with both parents?*YesNoIf not, with whom?Number of Children in Family*1234567Number of Children applying for a Scholarship*1234567Number of Years Applicant has attended Olympia*012345678910How did you hear about Camp Olympia?Has Applicant previously applied for a Camp Olympia scholarship?*YesNoHas Applicant previously received a Camp Olympia scholarship?YesNoPlease list any family members of the Applicant who have previously attended Camp Olympia summer camp.List 5 words that describe the Applicant.*Has the Applicant attended any other residential summer camps?*YesNoIf yes, which summer camp(s)?Has the Applicant had any behavioral or conduct issues at school, other camps, etc.?*YesNoIf yes, please explain:Each scholarship applicant family is expected to contribute a portion of the camper tuition to help offset the costs of the camper attending Camp Olympia. Please note that full tuition for a 2-week term is $3,750 and 3-week term is $4,750. How much will you contribute to the cost of the camp tuition for the Applicant?*Would anyone else contribute to the cost of the camp tuition?*YesNoIf yes, how much do you expect this other source to contribute?Note: At least one reference form must be completed by a NON-FAMILY member. Reference will be submitted from:*Below is a list of the Camp Olympia 2020 Summer Camp Term Dates. Please note that availability for scholarships varies within each term. *SPARK Week Terms are for 6-9 year old campers only. All other camp terms are for 7 – 16 year old campers. First Choice of Summer Term*PLEASE CHOOSETerm 1: May 31 – June 13 (14 days)Term 2: June 14 – July 4 (21 days)SPARK Week 1*: June 14 – June 20 (7 days)Term 2B: June 21 – July 4 (14 days)Term 3: July 5 – July 25 (21 days)SPARK Week 2*: July 5 – July 11 (7 days)Term 3B: July 12 – July 25 (14 days)Term 4: July 26 – August 8 (14 days)Second Choice of Summer TermPLEASE CHOOSETerm 1: May 31 – June 13 (14 days)Term 2: June 14 – July 4 (21 days)SPARK Week 1*: June 14 – June 20 (7 days)Term 2B: June 21 – July 4 (14 days)Term 3: July 5 – July 25 (21 days)SPARK Week 2*: July 5 – July 11 (7 days)Term 3B: July 12 – July 25 (14 days)Term 4: July 26 – August 8 (14 days)Third Choice of Summer TermPLEASE CHOOSETerm 1: May 31 – June 13 (14 days)Term 2: June 14 – July 4 (21 days)SPARK Week 1*: June 14 – June 20 (7 days)Term 2B: June 21 – July 4 (14 days)Term 3: July 5 – July 25 (21 days)SPARK Week 2*: July 5 – July 11 (7 days)Term 3B: July 12 – July 25 (14 days)Term 4: July 26 – August 8 (14 days)Please sign below that you, as Parent of the Applicant, want Camp Olympia to consider the Applicant for a Camp Olympia Scholarship.*NameThis field is for validation purposes and should be left unchanged.