Bacon Bash Texas Type 1 Diabetes Camp Scholarship Application

2023 Camp Scholarship Application

Bacon Bash Texas
Eligibility
- All applicants must be under the age of 18 and diagnosed with Type 1 Diabetes to qualify for camp scholarships.
- Scholarship applications must be submitted by November 30, 2022 for consideration for the 2023 camp season.
- Applicants must be pre-enrolled in a diabetes camp for the 2023 camp season.
- Only requests submitted on this form will be considered for funding.
- Applications must be completed in full, and include all required attachments, at the time of submission.
Application
Applicant Name *

First Name Last Name
Birthday *

Month Day Year
Male / Female *

Male Female
Date Diagnosed with Type 1 Diabetes *

Month Day Year
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Why do you want to attend camp? *
To be Completed by Student
What is the hardest part about living with Type 1 Diabetes? *
To be Completed by Student
Photo of Applicant: *

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Cancel of
Camp Information
Name of diabetic camp applicant is enrolled in? *
Camp Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Camp Registrar Phone Number *

Area Code Phone Number
Email *
[email protected]
Start Date *

Month Day Year
Date
End Date *

Month Day Year
Date
Cost of Camp *
Enrollment Verification *

This applicant has been enrolled/pre-enrolled at the aforementioned diabetic summer camp for the 2023 camp season.
Parent/Legal Guardian Information
Parent/Legal Guardian Name *

First Name Last Name
Phone Number *

Area Code Phone Number
Email *
[email protected]
Address (if different from Applicant's)

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Permissions *

If my child is selected for a scholarship, I give Bacon Bash Texas permission to use my child's photo, first name, age, and state, as well as quotes from our responses* on this application for promotional purposes. Featured locations could include, but are not limited to, printed materials, website features, social media, and e-mail newsletters. (*Financial information and intimate details will be kept confidential.) No, thank you.
How will this applicant benefit from attending camp? *
To be Completed by Parent / Guardian
Please make a brief statement describing why your child is in need of financial assistance. *
To be Completed by Parent / Guardian
What is your occupation / job title? *
What is spouse's occupation? *
The answers provided below are to be transferred from your most recent 1040, which will also need to be uploaded below.

What is the combined/total annual household income: Check the appropriate box. *

	Under $20,000	$20,000-$40,000	$40,000-$60,000	$60,000-$80,000	$80,000 and up
Income

Number of Dependents *
Line 6C on 1040, Line 5on 1040 EZ or Line 6C on 1040A.
Total Income *
Line 22 on 1040 or Line 15 on 1040 A.
Adjusted Gross Income *
Line 37 on 1040, Line 4 on 1040 EZ or Line 21 on 1040 A.
List Special Circumstances (If Any)
Most Recent 1040 or letter explaining exemption. *

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Cancel of
By signing this document, I agree that the information provided is accurate.
Parent/Legal Guardian Signature *

Clear
Please Note: Financial assistance is not guaranteed. Assistance will be given based on the availability of funds and level of need.

Scholarships will be awarded no later than March 2023, based on need and with priority given to applications submitted by the deadline.

Parents/legal guardians will receive scholarship notification (for both approved and declined applications) by e-mail no later than March 2023. Scholarship checks will be made payable to the camp and will be sent directly to the camp registrar.
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2023 Camp Scholarship Application

Eligibility

Application

Camp Information

Parent/Legal Guardian Information