Camp Diva Leadership Academy Financial Aid

Participants Name*

First Last

Email

Phone

Participant Birth Date*

Participant Grade Level*

Applicant (Parent) Name

First Last

What program are you requesting tuition assistance for?*

Camp Diva Leadership Academy
Girl Ambassador Program
GFAC After school Program
Immersion Lab Program

Address of Participant and Applicant

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

How much are you able to contribute to your participant's tuition.*

Did you file a tax return this year?*

Yes
No

Please list any additional dependents and members of the household. If none, please write N/A.*

If applying for assistance for Afterschool or summer camp, are you working or studying at least 20 hours per week?*

Yes
No

Why do you need financial assistance or a full scholarship from Girls For A Change ?*

Financial assistance and full scholarships are made possible through the generosity of donors . Are you willing to share your GFAC story to help support GFAC fundraising campaigns?*

Yes
No

Are you willing to volunteer? If so, in what area(s) would you be interested in volunteering?

Would you like to Join our Newsletter?

I agree to join the GFAC Newsletter.

Registration-Fee*

Price:

Credit Card

Card Details

Cardholder Name

Total

$0.00

CERTIFICATION OF INFORMATION By typing my full name I certify that the information listed on this form is correct to the best of my knowledge. I understand that Girls For A Change is a nonprofit organization and that financial assistance is made possible through the generosity of donors. I understand that financial assistance will be awarded on a first-come, first-served basis. I agree to notify GFAC if my financial situation improves, so that my financial assistance can be re-evaluated, thus providing more opportunities for others in our community. I understand that to maintain my financial assistance, GFAC may, upon request, require updated financial information. I will be afforded at least 30 days to provide information when requested. Failure to do so may lead to the revocation of my financial assistance or termination of placement*

BEFORE COMPLETING THIS FORM PLEASE REMEMBER THAT YOU MUST REGISTER FOR CAMP AND COMPLETE THE CAMP DIVA APPLICATION FIRST. PLEASE ONLY COMPLETE THIS FORM IF YOU ARE IN NEED OF FINANCIAL OR SCHOLARSHIP ASSISTANCE. YOU WILL BE CHARGED A 25.00 FEE IF YOU APPLY FOR THIS SCHOLARSHIP AND FINANCIAL ASSISTANCE FORM. THIS IS NOT A REGISTRATION FORM

Have you completed a registration form? If you have not completed a registration form please do that first. No refunds will be given if you do not complete a registration form first.*

Camp Diva Leadership Academy Financial Aid

Every Black Girl -Tuition Assistance

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