2017 Scholarship Application Please complete and submit this form by May 15th if your child will not be able to attend Camp this summer without some form of financial assistance. Camper's Name* First Last Parent/Legal Guardian's Name* First Last Current Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email Home Church*Name, City (e.g. Grace, St. Joseph)Synod*ELSWELSPastor's Name*Pastor's Phone*Personal Reference* First Last Reference's Phone*Housing*RentOwn HomeEmployment*Full timePart timeIf currently unemployed, enter # of weeks in 'Other' boxHave you had children attend Camp Lor-Ray in the past?YesNoBriefly describe the circumstances requiring you to ask for assistance at this time:* How many children do you wish to send to Camp Lor-Ray this summer?1234How much assistance are you requesting?*25%50%75%100%Additional comments (things you'd like the Executive Committee to consider): Please allow several weeks for the Executive Committee to review and approve your application. Typically, applications are reviewed in mid-May and responses are sent out in early June. All information is held in strictest confidence for our mutual benefit. If at some other time you are blessed with additional resources, please remember Camp Lor-Ray with a donation towards the Financial Aid Fund to help us assist other families as the need arises.