CBJ Kids to Camp Application - Community Foundation of Dunn County

Email

This field is for validation purposes and should be left unchanged.

Applicant Information

Eligibility Question

Camper lives in Dunn County, Wisconsin
Camper Attends School in Dunn County, Wisconsin
Camper lives or attends school in county adjacent to Dunn County (Barron, Chippewa, Eau Claire, Pepin, Pierce, Polk, or St. Croix)
Camper does not live in or attend school in Dunn County or adjacent county (likely not eligible for this scholarship; call the Foundation at 715-232-8019 before proceeding)

Name*

First Last

Mailing Address*

Street Address Address Line 2 City State ZIP Code

Age*

Parent/Guardian Email*

Phone*

Have you received a Kids to Camp Scholarship in the past?*

Yes
No

How did you hear about this opportunity?

Camp Information

Qualified camps are those that are specifically designed for youth and young adults that have Type I Diabetes. Camps may be for educational, athletic, or other types of personal development. Please ensure you meet the camp's own eligibility requirements before applying for a scholarship.

Name of the camp that you plan to attend:*

Camp Mailing Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Camp Website*

Please provide the URL of the camp's official website so we can verify the programs offered, their American Diabetes Association certification, etc.

Camp Dates*

Please provide the dates of the camp you wish to attend. To be eligible for a scholarship, the application must be submitted at least (8) weeks prior to the camp.

Total Cost of Camp*

Amount Paid To Date, if any:*

Scholarship amount you are requesting:*

Scholarships from $250 to $850 are available and are paid directly to the camp unless otherwise approved by the Community Foundation of Dunn County, Inc. Any income tax liability that could result as the result of a direct tuition reimbursement is the responsibility of the applicant or parents as may be applicable.

Please enter a number from 250 to 850.

Have you registered for the camp?*

Yes
No

If so, please upload a copy of the completed camp registration.

Max. file size: 512 MB.

Essay

The youth applicant must provide a short essay of 250-500 words describing how being able to attend camp will (1) make a difference in your life and (2) how you can use the camp experience to help other young people facing the challenges of living with diabetes.

Essay Submission Method*

Please choose how you wish to submit the essay requirement:

I will type the essay into this form below.
I will upload the essay file to this form.

Essay Submission*

In 500 words or less, please describe how being able to attend camp will (1) make a difference in your life and (2) how you can use the camp experience to help other young people facing the challenges of living with diabetes.

Essay Upload*

Drop files here or

Max. file size: 512 MB.

Authorization*

I certify that the information provided in this application is complete and accurate to the best of my knowledge. I understand that falsification of information will result in termination of any scholarship granted. I understand that incomplete applications may not be considered. I certify that I have read the instructions and will comply with all requests for documentation. Should I receive a scholarship, I will notify the Community Foundation of Dunn County (CFDC) of any change of plans. The CFDC may use my name and likeness in publicity materials relating to the Foundation. I understand the CFDC scholarships may only be used toward the published cost of attendance at qualified camps.