APPLICATION FOR FINANCIAL AID

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					                                                 SCHOLARSHIP APPLICATION
                                            MOSES BROWN SUMMER CAMPS 2010
                                                     Moses Brown PLUS
                           250 Lloyd Avenue       Providence, RI 02906 401-831-7350, Ext. 296

                      [Please mark an X next to each camp for which you are requesting Financial Aid]

 RISE Camp (ages 5-14) ______ Preschool Camp (ages 3-4) ______ Summer’s End Camp (ages 4-14) ______
                 Chess Camp (ages 5-16) _______ Sports Camps (ages 4-16) _______

In an effort to distribute awards in the fairest possible manner and in accordance with need, the parents of each
applicant are asked to complete this questionnaire. All of this strictly confidential information will be made available
only to those who are immediately concerned with the granting of scholarships. A copy of your last pay stub OR
the first page of your latest income tax return must accompany this application, in addition to a completed
registration form for each camper.

Name of Camper________________________________ Age ___________Grade completed in June, 2010_______

Name of Camper________________________________ Age ___________Grade completed in June, 2010_______

Parent/s Name_____________________________________ Home Phone___________ Work Phone____________

Address______________________________________ City _______________                           State________ Zip____________

Married________         Divorced_________       Separated_________         Spouse deceased________            Single__________

List all dependent children, starting with camper/s:
First Name             Age                School Attending                                 Annual Education Expenses

1.___________________________________________________________________________________________

2.___________________________________________________________________________________________

3.___________________________________________________________________________________________

Father’s Occupation__________________________________________ Annual Gross Income = $_________________________

Mother’s Occupation__________________________________________ Annual Gross Income = $________________________

                                                                           Total Gross Income = $________________________

Please provide the following information based on MONTHLY income……………...

Total TAKE HOME Monthly Income MONTHLY EXPENSES (specify)
                                            ITEM                                                  AMOUNT
Father ________________              ____________________                                  __________________

Mother________________                              ____________________                   __________________

Other_________________                              ____________________                   __________________
(alimony, social security benefits, etc.)
                                                   ____________________                    __________________

                                                   _____________________                   __________________

                                                                                 Total = $ _________________

               Total Assets (home, vehicles, investments, other Real Estate) = $ _____________________

            Total Indebtedness (unpaid mortgages, loans, charge accounts) = $ _____________________

           Please fill in every line and use reverse side if you need more room or wish to give additional information.
 Your award decision will be made on a first come-first served basis. You will be notified as soon as your application and
                     check stub and/or first page of last income tax return are received and reviewed.



                     To the best of my knowledge all information reported on this form is complete and accurate.

Signature____________________________________________________________Date_____________________

				
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