GSDSW Resident Camp Financial Assistance Application

Financial assistance is available only to girls attending Girl Scouts of the Desert Southwest's Camp Mitre Peak. A Camp Registration and deposit must be completed and submitted online prior to your Financial Assistance Application. If financial assistance is not accepted and you withdraw your application, your deposit will be refunded. Please complete the ENTIRE form and hit submit. Incomplete forms will not be processed.

Financial Assistance deadine is Sunday, April 30, 2023.

PART 1: CAMPER INFORMATION

First Name *

Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

PARENT / CAREGIVER INFORMATION

First Name *

Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address *

Session and Program *

PART 2: PROGRAM INFORMATION

You may apply for financial assistance for only ONE SESSION of camp per girl. Programs vary in length and awards will be based on the cost of one session of your camp registration:

1. Camp Session Cost *

2. Deposit paid online *

3. Estimate Desert Dollars to be applied to camp fee (cannot be used for deposit) *

4 . Additional amount you can pay *

5. Total (Add #2, #3, #4) *

6. Amount of financial assistance requested (subtract #5 from #1) *

PART 3: INCOME INFORMATION

List total yearly income of household received from salaries, wages, alimony, child support, social security, disability, public assistance, etc. *

Number of adults in household supported by this income *

Number of dependent children (under 18) in household supported by this income *

Please explain any unusual family expenses (medical, unemployment, death, emergency situations, etc.)

ACKNOWLEDGMENT

The information above is complete and accurate and I understand that proof of income may be requested by the committee considering this request for financial assistance. If my girl does not attend camp and four weeks notice in writing is not given to the Girl Scout office, I understand I am responsible for the full camp fee. Final awards depend on family contributions received (Desert Dollars and payments).

This information is confidential and only council staff will see this information. No one working at camp will have this information.

Signature *

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