Pilgrim Pines Campership Application & Instructions

1 Pilgrim Pines Campership Application & Instructions Thank you for applying for Campership funds for your camper to attend our 2018 Summer Camp. Below are the step by step Instructions for applying for Campership assistance. Completing an Application for a Campership is not a guarantee of assistance, and awards are based on available funding. Should you have any questions, please feel free to contact us by email (preferred) at or by phone at (909) 566-CAMP (2267). Additional forms and information are available through our website Step One: Complete registration and pay deposit. Registration information can be found at our website. Registrations can be completed online, or you may request a paper Application by email or phone. A $100 deposit is required at the time of registration. We must ask that each family make this payment at the time of registration to secure your camper s place at camp.

2 Registrations must be complete and deposits must be received before we can process your Campership Application . Step Two: Complete the enclosed Campership Application . Please complete the enclosed Application in its entirety. Remember that incomplete forms will delay processing of your Application and may cause you to lose funding for your camper. Eligibility is determined based on family income. There are three ways that a camper can qualify: 1. Your camper is receiving public assistance, such as WIC, SNAP, or Medi-Cal. A copy of the benefits card or other documentation is required. 2. Your camper and their family have an income within the requirements listed below. Proof of income ( pay stub) is required. 3. Additional funds may also be available for campers who do not fall within the above guidelines. For these requests, you must complete the Supplemental Application and give a reason for the request ( paying for multiple campers, high medical bills, etc.)

3 When completing your Application , please keep in mind that a camper s specific award is based on funding available, on a first submitted/first awarded basis. The earlier you return your Application , the greater your chances of being awarded a Campership . A typical Campership award is for $200-$250. If you request a Campership for the full balance, your request may be granted only in part. If your camper is not approved for a Campership , and/or is not able to pay for camp once their Application has been processed, the $100 deposit can be refunded upon request. Step Three: Return your Application . Once you have completed your Application and documentation, you can return it in one of three ways: 1. Scan the Application and all documents and email them to 2. Fax all documents to our Fax Line at (909) 886-4912. Please be sure to write Pilgrim Pines 2017 Campership on your cover sheet.

4 3. Mail all documents to the following address: Pilgrim Pines 2018 Camperships 39570 Glen Road Yucaipa, CA 92399-9505 Due to limited funding and resources, applications must be received or postmarked by June 1, 2018. ANY applications RECEIVED OR POSTMARKED AFTER THIS DATE WILL NOT BE ACCEPTED, REGARDLESS OF ELIGIBILITY. Step Four: Check for correspondence and award information. When your Application has been received, you will get either an email or postcard confirmation that we have your Application . IF YOU DO NOT GET CONFIRMATION OF RECEIPT OF YOUR Campership Application WITHIN 14 DAYS OF RETURNING IT, PLEASE CONTACT US. ALL AWARDS AND NOTIFICATIONS WILL BE SENT AFTER MAY 15th. After this date, we will contact you either by email or mail with a decision. If your camper has been awarded assistance, you will receive information in regards to the amount of assistance and how to pay for the balance, if applicable.

5 If your camper is not awarded assistance, you will be notified of the reason and given further information. Please contact us after this date if you have not received information regarding your camper s Application . FAMILY INCOME REQUIREMENTS (WIC2017-2018 Income Eligibility Guidelines) Household Size* Annual Income (per year) Monthly Income Twice Monthly Income Bi-weekly Income Weekly Income 1 ** $22,311 $1,860 $930 $859 $430 2 30,044 2,504 1,252 1,156 578 3 37,777 3,149 1,575 1,453 727 4 45,510 3,793 1,879 1,751 876 5 53,243 4,437 2,219 2,048 1,024 6 60,976 5,082 2,541 2,346 1,173 Each Add'l family member add + $7,733 + $645 + $323 + $298 + $149 Definitions (for Family Income Requirements Chart) * Household means a group of related or non-related individuals who are living as one economic unit and sharing living expenses. Living expenses include rent, clothes, food, doctor bills, utilities, etc.

6 ** A household of one means a camper who is his/her sole support. Foster children are one member households only if the welfare/placement agency maintains legal responsibility for the child. ALL CAMP CORRESPONDENCE WILL BE SENT TO THE ADDRESS LISTED ABOVE LIST who camper lives with (parents, mother, father, grandmother, Foster parents, siblings, etc.) LIST each person. TOTAL # of people living in household. TOTAL household yearly income from all paying jobs. Do not include public assistance List occupations of all household members: Does the family receive social service aid? If yes, attach proof of assistance, such as a Cal-Fresh or Medi-Cal Benefit Card. YES NO Has your camper attended Pilgrim Pines Summer Camp before? YES NO How much do you request in Campership funds from Pilgrim Pines Camp? $ _____ Please remember that if the full amount you are requesting is not available, your may receive only part of your request.

7 Acceptance and participation in the program is the same for everyone without regard to race, color, ethnicity, creed, national origin, age, gender, sexual orientation, or special needs status, providing financial requirements are met. All applicants must be eligible for camp participation according to the guidelines set for participation in each program, ie: Mini, Junior, Junior High, Senior High, Pinester, Seedlings, PineCones and all other Summer Camp programs. Pilgrim Pines Camp and Conference Center 2018 Campership Application IF a Campership is not granted, the $ deposit will be refunded. Please LEGIBLY print or type both pages of this form. Check the Campership Application Instructions for more information, or for information on how to contact us. Mail completed forms to Pilgrim Pines 2016 Camperships, 39570 Glen Road, Yucaipa, CA 92399. Proof of income is REQUIRED in order to process this Application .

8 Please note that incomplete forms will not be processed. All boxes must be filled in- if not applicable, please indicate N/A. All information on this Application is strictly confidential. Camper's Name: First Last Address City State Zip Code Date of Birth Gender: M F Grade Entering in Fall 2018 Age on 7/01/18 RACIAL/ETHNIC GROUP: Please check a box. Some of our donors request this data if available. African American Native American Asian/ Pacific Islander Latino/a Caucasian Other Is camper from a UCC church? If yes, please list CITY and church. 1st Parent, Guardian or Foster Parent Name Relationship Daytime Phone Night-time Phone Cell Phone 1st Parent or Guardian Address State Zip Code Email Address 2nd Parent, Guardian or Foster Parent Name Relationship Daytime Phone Night-time Phone Cell Phone 2nd Parent, Guardian or Foster Parent Address State Zip Code Email Address Daytime phone of person signing this form What is your relationship to the camper?

9 Signature and Date FOR OFFICE USE ONLY Date Received Date Processed Total Fees Amount Requested Total Amount Awarded Notification Date Week Program Pilgrim Pines Summer Camp- 2018 Campership Application Supplemental Application The following information is requested if you are completing an Application and do not fall in the income/assistance guidelines. Please complete this form in its entirety and submit with your Application . Feel free to contact us should you have any questions. applications ARE DUE BY JUNE 1, 2017. All information contained in this Application is strictly confidential. Camper Information - Please answer all questions and be as descriptive and specific as possible. Has your camper been to Pilgrim Pines Camp in the past? Yes No If yes, please list year (s) _. 1. Please describe the camper's neighborhood and home environment. Please be specific. 2.

10 What hardships/struggles, if any, has your camper encountered that negatively impacted him or her? 3. How do you foresee him/her benefiting from the Summer Camp experience at Pilgrim Pines ? 4. Describe the camper's strengths, interests and future goals. 5. Describe what activities your camper and your family has engaged in to raise money for camp. 6. Please explain the financial circumstances which cause you to request Campership support. PLEASE RETURN COMPLETED FORMS TO Pilgrim Pines BY JUNE 1, 2018.