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Name
*
First
Last
Date of Birth
*
Phone
*
Email
*
Emergency Contact Name
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Emergency Contact Number
*
Race
*
American Indian/Alaskan Native
Asian
Black or African American
White
Native Hawaiians or Other Pacific Islander
Bi-racial/Multiracial
Other
Gender
*
Male
Female
Ethnicity
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Hispanic or Latino
Non-Hispanic or Latino
Households Info Section: List all household members and their relationship to you.
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Name / DOB: 02-22-2023 / Age / Relationship to you. Ex: Child
Campers Info Section: List all children applying for the scholarship and their relationship to you.
*
Complete this section for age eligible summer camper(s) ages 5-14 (Children of specialized population are between the ages of 5 and 17) by June 1st. 5 year old(s) must provide proof that they are currently attending or have completed VPK.
___________________________________________________________________________________________________________________
Attachments for Application Section Please email the required documents below in separate files. to
[email protected]
.
* Copy of Proof of Palm Beach County Residency (Ex. recent utility bill, school demographics with camper’s name and address, driver’s license, etc.)
* Copy of Photo ID (Upload one of the following Driver's License, US Passport, Resident Card, Work Permit)
Note:
The file format must be a .pdf, .docx, .doc, .dotx, .xls, .xlsx, .xltx, .jpg, .jpeg, .png, .bmp, .tif.
Note:
ELC Camper(s) are not eligible for scholarship and system will not allow you to enter the camper(s).
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