Camp Little Notch
2017 Campership Application
Hello!!
Thank you for your interest in our summer programs here at Camp Little Notch! We are happy to review your application
materials for a Campership to support you sending your child to camp for the 2017 season.
Please note the following:
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The amount of money awarded depends on demonstrated need.
Camperships are awarded on a first-come, first-served basis.
Camperships are awarded for a single camp session per child per summer.
More than one child in the family may be awarded a Campership.
A deposit of $25 per camper must be submitted with the Campership application. If you are awarded a Campership
and register for camp, this deposit will be applied toward the applicable cost of your child attending CLN. If you are
awarded a Campership and choose not to register, your deposit will be fully refunded to you.
● Once a Campership is awarded, you will have seven (7) days to register for camp and thus redeem the Campership. If
you do not register your child within this timeframe, we will reallocate the Campership funds to the next qualified
applicant.
● Please submit the following materials:
o Campership Application (one per family)
o Proof of Income (A signed IRS 1040 or 1040ez form, and W-2 forms)
o If applicable, a letter explaining any extenuating circumstances affecting your ability to pay the camp fee.
Completed applications (including all required documents) will be reviewed by the Finance Committee in the order in which
they are received. You will be notified in writing of any missing items or incomplete applications. Please keep in mind that this
will delay the processing time of your application and may affect the amount to be awarded.
Processing takes approximately 2-3 weeks. You will receive a letter about your Campership award. Camperships will be
awarded until the available Campership Funds are depleted.
If you have any questions, or need help in completing the forms, please contact Andrea B. Cirabisi, Executive Director, at
(518) 817-8892 by email andrea.cirabisi@friends ofcln.org or Susan Smith-Franks , Friends of Camp Little Notch Treasurer, at
[email protected].
We are excited that your child is interested in attending Camp Little Notch! We look forward to welcoming your child to a
place that provides opportunities for all people to practice living in harmony with nature, each other, and themselves.
Sincerely,
Andrea B. Cirabisi, Executive Director
Susan Smith-Franks Board of Directors Treasurer
Friends of Camp Little Notch
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2017 Campership Application
2017 CLN Campership Application
The base cost to attend CLN is $510 per week. Please circle the amount of this cost that you are able to pay, per camper.
This must be filled out or your application cannot be processed. This is in addition to the registration deposit.
$50
$100
Application Date: ____________________
$200
$300
$400
Other: _________
Camper Name(s): ___________________________________
APPLICANT INFORMATION (adult)
First
Name:
Last Name
Date of Birth
/
/
Home Address:
City
State
County of Residence:
Home
Phone
Wor
k
Pho
ne
Zip
Cell
Phone
Please list all household members living at the same residence, including campers & other children.
NAME
BIRTH DATE
RELATIONSHIP
(month/day/year)
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
CURRENT INCOME OF HOUSEHOLD
Must attach documentation to support all income.
Page 2 of 3
Applicant’s employment $
q
Monthly
q
Annually
Spouse/others in house $
q
Monthly
q
Annually
Child Support $
q
Monthly
q
Annually
Disability Income $
q
Monthly
q
Annually
SSI $
q
Monthly
q
Annually
TOTAL INCOME $
q
Monthly
q
Annually
2017 Campership Application
2017 CLN Campership Application
Camperships are awarded based on financial need. To help us determine your eligibility, please indicate if you are currently
receiving any assistance from any of the programs or organizations listed below. Please include documentation to confirm the
source of financial aid indicated below.
Please check all applicable programs below:
q School lunch program q Food Stamp program q Welfare q Social Security
Social Service Agency, Agency name: ____________________________________
Attach a copy of your Federal Income Tax Return (1040 or 1040ez) for this year or last year if you have not filed yet. If you
do not have a tax return, please explain and submit other documentation of household income.
If you have circumstances affecting your ability to pay, which are not included above, please attach a letter explaining your
situation.
PLEASE READ THE FOLLOWING CAREFULLY:
A sliding scale based on total annual income will be utilized to assist in determining financial assistance to be provided.
Extenuating circumstances affecting living expenses (e.g., medical expenses, catastrophe, debt, etc.) will also be considered. By
signing this application, I certify that the information on this form is true and complete. I understand that any person who
knowingly and with intent files an application containing any false, incomplete or misleading information may have benefits
revoked and be held personally responsible for all illegally obtained benefits. I have attached all documentation and I
understand that this documentation will be used to assess my campership qualification.
_________________________________________________________________________
Signature of Applicant
Print Name______________________________________________ Date ______________
Process of financial assistance:
1. Complete and sign application.
2. Attach copy of current income tax form (1040 or 1040ez) along with supporting documents (W2 forms).
IMPORTANT! Please white out or remove social security numbers before submitting with application.
3. Attach documentation of income listed on application.
4. Attach a letter regarding any extenuating circumstances to support your application.
5. MAIL Campership application and $25 deposit to:
Friends of Camp Little Notch
110 Spring Street, Saratoga Springs, NY 12866
Attention: Camp/Financial Assistance
6. Allow 2 - 3 weeks for processing. Apply early!
7. You will receive a letter stating the amount of financial assistance that Friends of Camp Little Notch can provide. You
must register your child within 7 days of award notification or the campership award will be voided and used for other
campers.
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2017 Campership Application