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Get 2013 National Scout Jamboree Campership Application Form

Boy Scouts of America Summit Department 2013 NATIONAL SCOUT JAMBOREE CAMPERSHIP APPLICATION Send the completed form no later than October 1 2012 Please send this form marked Personal and Confidential to Jeffery C. Stout Boy Scouts of America P. O. Box 152079 1325 W* Walnut Hill Lane Irving TX 75015-2079 Note Information in red is required* Incomplete applications will not be considered* CONFIDENTIAL INFORMATION To protect your private information Part B should be completed by the unit leader first. PART A to be completed by a parent/guardian APPLICANT S INFORMATION Name Home Scout Troop/Venturing Crew Number Home Address City State Home Telephone Number Zip Date of Birth Age Name of Parent or Guardian Council Headquarters City FINANCIAL NEED What distinguishes your need from others that sets you apart What are you doing to raise funds EMPLOYMENT Father/Guardian Employer Position FAMILY SIZE Please indicate the number of income tax dependents currently residing in your home 8 or more 5-7 4 or fewer Total Annual Household Income One Parent Household Two Parent Household One Income Family Two Income Family AFDC/Welfare/Food Stamps/Foster Care Number PLEASE LIST EMPLOYMENT MEDICAL OR OTHER INFORMATION THAT CAN BE HELPFUL Confidential Page 1 The amount requested from the campership fund is I attest that all information and statements on this form are true and correct. Signature of parent/guardian Date family member an assistant leader should complete this section* Name of Leader Troop Address Daytime Phone Evening Phone What is the Scout s/Venturer s ethnic group African American American Indian Asian Hispanic White Other Describe and/or give examples of why the Scout/Venturer needs assistance List the positive qualities the Scout/Venturer has demonstrated that illustrate the reason to be chosen for a campership What are the Scout s/Venturer s interests and future goals Signature of leader FOR REGIONAL OFFICE USE ONLY Date application received Application meets income guidelines Membership verified Yes No Application approved for Reason for denial if any Signed by 1/14/2012. Stout Boy Scouts of America P. O. Box 152079 1325 W* Walnut Hill Lane Irving TX 75015-2079 Note Information in red is required* Incomplete applications will not be considered* CONFIDENTIAL INFORMATION To protect your private information Part B should be completed by the unit leader first. PART A to be completed by a parent/guardian APPLICANT S INFORMATION Name Home Scout Troop/Venturing Crew Number Home Address City State Home Telephone Number Zip Date of Birth Age Name of Parent or Guardian Council Headquarters City FINANCIAL NEED What distinguishes your need from others that sets you apart What are you doing to raise funds EMPLOYMENT Father/Guardian Employer Position FAMILY SIZE Please indicate the number of income tax dependents currently residing in your home 8 or more 5-7 4 or fewer Total Annual Household Income One Parent Household Two Parent Household One Income Family Two Income Family AFDC/Welfare/Food Stamps/Foster Care Number PLEASE LIST EMPLOYMENT MEDICAL OR OTHER INFORMATION THAT CAN BE HELPFUL Confidential Page 1 The amount requested from the campership fund is I attest that all information and statements on this form are true and correct.

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