Soil Born Farms Summer Day Camp
Scholarship Request Form
Financial Aid Guidelines
Soil Born Farms, a non-profit organization, operates with very limited resources and our ability to provide
scholarships is made possible by Board members, private donors, and those who contribute to the scholarship
fund. These funds are very limited and based on the total of paid-in-full registrations. We require that
applicants requesting Financial Aid submit a copy of your IRS-Verified Income Transcript, most recent IRSVerified Tax Return information or a verification of non- filing. This can be obtained by filing a Form 4506-T to
the IRS. We will be unable to provide scholarships without fully verified income information.
If you would like to be considered for a scholarship to Soil Born Farms Summer Day Camp,
please:
1. Select the course you would like to attend.
2. Complete, sign and date this Scholarship Request Form and mail the original application with support
materials to Soil Born Farms Attn: Summer Day Camp, P.O. Box 661175, Sacramento, CA 95866.
3. Include a copy of your IRS-Verified Income Transcript, Tax Return (W-2 or Form 1040) or Verification
of Non-Filing
4. Read the financial aid guidelines thoroughly. Please make sure to sign the form twice, once indicating
you have read the financial aid guidelines and once after completing your personal and financial
information.
Household income under $50,000: Most of our full financial aid goes to campers from households with a total
annual income of less than $50,000. If your household income falls into this category, please request full
financial aid.
Household income between $50,000 and $80,000: Most partial financial aid goes to children from households
with a total annual income between $50,000 and $80,000. Please request full financial aid if needed, or if you
are able to pay tuition, let us know how much you can afford to pay.
Household income above $80,000: We are generally able to consider financial aid for households with a total
income of greater than $80,000 only in extreme, extenuating circumstances, such as medical hardship, recent
job loss, or a large number of dependents (i.e. financial responsibility for extended family members). We cannot
grant financial aid due to a child who is enrolled in multiple programs outside of Soil Born Farms Summer Day Camp,
or other situations involving elective activities, private school tuition, etc. However, if you feel you need financial
assistance, please submit a financial aid form with an explanation, and we will review it.
In Fairness to all scholarship recipients we ask that you only request financial aid for the week that you are
sure your child will be in attendance.
I have read the above financial aid guidelines.
Sign: __________________________ Print:___________________________ Date: _______________
Soil Born Farms Summer Day Camp Scholarship Application
Child’s First Name:_____________________________________
Last Name: __________________________________________
Date of Birth: ________
Age (at time of camp): _____________
Home Address: _______________________________________
City:___________________________
State:__________
Zip:____________
Name of Primary Contact/Parent/Guardian: _________________________________
Primary Contact's Relationship to Child: ____________________________________
Home Phone:_____________________
Cell Phone:________________________
Work Phone:__________________________
Email:_________________________
Names of any siblings/relatives also applying this year:____________________________
Estimated Annual Household Income: $_____________________
# of Adults in Household:___________
Are you currently employed? Yes
# of Children in Household:_____________
No
Employer: ____________________________
Spouse’s
Employer: ____________________________
Occupation: ___________________________
Occupation: ___________________________
Mo/Yrs. with employer __________________
Mo/Yrs with employer __________________
Total household income (including alimony, child support, etc.):
_____ less than $20,000 _____ $30,000-40,000 ____ $50,000-60,000 _____ $70,000-100,000
____ $20,000-30,000
_____ $40,000-50,000 _____ $60,000-70,000 _____ more than $100,000
How much can you afford to pay towards your camper's tuition? This is required if you are applying for
financial aid.
___ I can afford to pay $ _________
___ I cannot afford to pay any tuition
Please describe your interest in enrolling your child in Summer Day Camp at Soil Born
Farms:______________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
____________________________________________
_________________________________________________
If needed, feel free to explain your situation further on the back of this page.
I certify that the information and responses are true to the best of my knowledge.
Sign: _______________________ Print:________________________ Date: _______________
If you have any questions about the application process, please call Alyssa Kassner, Youth Education
Coordinator at 916-363-9685 ext. 1012 or email [email protected]. Scholarship awards are based on
need and will be awarded in order that completed forms are received.
FOR OFFICE USE ONLY Date received:_______ Points: ______ Aid Award $______________
Camp Name ____________ Week of ___________ Session
Wait List______ Notes: