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Black Lake Scholarship Request

Parent/Guardian Name

First Name *

Last Name *

Phone Number

Email *

Address

Address *

City *

ZIP Code *

State *

Student Name

First Name *

Last Name *

What is your current involvement with All City Church?

What is your current involvement with the church? *

Your involvement is not a pre-requsite for assistance.

Have you received a scholarship before? *

Please state the reason(s) you feel need of aid: *

The total cost of this camp is $540.

I am asking for a scholarship in the amount of: *

$100 Scholarship

$200 Scholarship

Half Scholarship

Other Amount

Amount *

Signature *

Date

Leave this field blank