Camper Scholarship Application Camper Scholarship Application Camper's Full Name* Camper Age*PLEASE CHOOSE678910111213141516Sex* Female Male School (2022-2023 school year) School Grade (2022-2023 school year)*Kindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade6th Grade7th Grade8th Grade9th Grade10th GradeParent 1 Full Name* Parent 2 Full Name Home 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 FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÃ…land Islands Country Parent 1 Phone*Parent 2 PhoneParent 1 Email* Parent 2 Email Parent 1 Occupation* Parent 2 Occupation Parent 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* Yes No Additional Income Amount per MonthIs Camper living with both parents?* Yes No If 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?* Yes No Has Applicant previously received a Camp Olympia scholarship? Yes No Please 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?* Yes No If yes, which summer camp(s)? Has the Applicant had any behavioral or conduct issues at school, other camps, etc.?* Yes No If 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 $4,450 and 3-week term is $5,575. 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?* Yes No If yes, how much do you expect this other source to contribute?Note: Reference(s) must be completed by a NON-FAMILY member. Reference will be submitted from:* Below is a list of the Camp Olympia 2023 Summer Camp Term Dates in which scholarships may be available. Please note that availability for scholarships varies within each term. First Choice of Summer Term*PLEASE CHOOSETerm 1: May 28 – June 10 (14 days)Term 2: June 11 – July 1 (21 days)CLP 2: June 11 - July 1 (21 days)Term 3: July 2 – July 22 (21 days)CLP 3: July 2 - July 22 (21 days)Term 4: July 23 – August 5 (14 days)Second Choice of Summer TermPLEASE CHOOSETerm 1: May 29 – June 11 (14 days)Term 2: June 12 – July 2 (21 days)CLP 2: June 12 – July 2 (21 days)SPARK Week 1*: June 12 – June 18 (7 days)Term 2B: June 19 – July 2 (14 days)Term 3: July 3 – July 23 (21 days)CLP 3: July 3 – July 23 (21 days)SPARK Week 2*: July 3 – July 9 (7 days)Term 3B: July 10 – July 23 (14 days)Term 4: July 24 – August 6 (14 days)Third Choice of Summer TermPLEASE CHOOSETerm 1: May 29 – June 11 (14 days)Term 2: June 12 – July 2 (21 days)CLP 2: June 12 – July 2 (21 days)SPARK Week 1*: June 12 – June 18 (7 days)Term 2B: June 19 – July 2 (14 days)Term 3: July 3 – July 23 (21 days)CLP 3: July 3 – July 23 (21 days)SPARK Week 2*: July 3 – July 9 (7 days)Term 3B: July 10 – July 23 (14 days)Term 4: July 24 – August 6 (14 days)Please sign below that you, as Parent of the Applicant, want Camp Olympia to consider the Applicant for a Camp Olympia Scholarship.* PhoneThis field is for validation purposes and should be left unchanged. 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