BOYS & GIRLS CLUB OF CAPE COD FINANCIAL AID …



BOYS & GIRLS CLUB OF CAPE COD FINANCIAL AID APPLICATION FORM

Please note that the deadline for submission of all financial assistance material is May 23, 2008.

INSTRUCTIONS

1. Please read the information and instructions contained on this page carefully.

2. Complete and sign the Financial Assistance application on the reverse side.

3. Attach a copy of your 2007 1040 Federal Tax Return and your last four payroll stubs or public assistance notification. Any information that verifies other current household income must be included.

4. A 40% deposit must accompany the application to guarantee a slot and process your application.

5. Mail your application and supporting documentation by May 23, 2008 to:

Boys & Girls Club of Cape Cod

Attention: Camp Director

P.O. Box 895

Mashpee, MA 02649

(508) 477-8845

Checklist for Applications: Before Mailing Your Completed Packet, Be Sure it Includes:

( 1. 20071040 Federal Tax Return

( 2. Complete and signed Boys & Girls Club of Cape Cod Financial Aid Application for each child.

( 3. Last four payroll stubs or public assistance notification.

( 4. Any other documentation that will support your request.

( 5. A complete camp registration form with a 40% deposit.

FINANCIAL ASSISTANCE POLICY

It is the policy of the Boys & Girls Club of Cape Cod to provide services to all who wish them regardless of their ability to pay. While the Boys & Girls Club sets fees at rates affordable to the majority of residents in our service area, financial assistance is available to those who cannot afford those fees. Assistance is awarded based on each applicant’s ability to pay and the funds available. Last year, requests for assistance far exceeded our available funds. Please get your applications to us as soon as possible.

A deposit of 40% of the total bill is required at registration and will be applied to the parent portion of the bill. All deposits are non-refundable if financial aid is awarded. Registration fees are not refundable. Applicants are required to pay some portion of the program fee for which they are requesting assistance. This contribution demonstrates both a desire and a commitment to participate. The deposit will be applied towards the parent portion of the bill.

ELIGIBILITY

Any resident of Cape Cod may apply. Financial Assistance will be granted based on the need demonstrated by household income and/or extenuating circumstances.

**If family income is under $22,000, we suggest that you contact Child Care Network for a voucher.

SELECTION PROCESS

Applications will be reviewed for eligibility by Boys & Girls Club of Cape Cod Camp Director. Award decisions will be made by June 4th, 2008 and award letters will be mailed by June 6th, 2008.

FUNDING

Financial Assistance is made possible by charitable contributions to the Boys & Girls Club of Cape Cod from individual sponsors and friends of the Club, the Willowbend Children’s Charity, and the Cape Cod Times Needy Fund.

SUBMISSION DEADLINE May 23, 2008

1. AVAILABLE SESSION DATES (Please number the weeks that you prefer) First preference is based on first come first served. We will do our best to accommodate the applicant’s needs.

Week 1 (6/25-6/29) ____ Week 2 (6/30-7/4) ____ Week 3 (7/7-7/11) ____

Week 4 (7/14-7/18) ____ Week 5 (7/21-7/25)____ Week 6 (7/28-8/1)____

Week 7 (8/4-8/8)_____ Week 8 (8/11-8/15)_____ Week 9 (8/18-8/22)____

2. APPLICANT INFORMATION

Camper Name___________________________________ Date of Birth______________ Male______ Female______

Mailing Address_________________________________________ Home Phone_______________________________

Applicant Name ________________________________ Telephone ________________ Cell Phone______________

Address (if not same as above)_________________________________________________________________

Email______________________________________________________________________________________

Business Name________________________________________________ Phone_______________________________

Camper’s relationship to applicant___________________________________________________________________

Have you ever received financial assistance from the Boys & Girls Club of Cape Cod? YES _____ NO ____

If yes, when and for which program? __________________________________________________________________

Will you receive financial assistance from any other source? YES __________ NO ___________

If yes, what source and how much?_____________________________________________________________________

3. Ethnic Origin (Optional) – for funding sources ONLY, will not affect award decision.

____ Native American ____ White/Caucasian

____ Asian/Pacific Islander ____ Spanish/Hispanic

____ African American ____ Multi-Racial

____ Cape Verdian ____Other _________________________

4. FINANCES (by month)

Current Household: Number of Adults ____________________ Number of Children ___________________

Income ( list below) Expenses ( list below)

Gross Monthly____________________________________ Rent/Mortgages__________________________

Household Wages__________________________________ Food__________________________________

Child Support_____________________________________ Medical_________________________________

Public Assistance__________________________________ Car____________________________________

Food Stamps______________________________________ Tuition_________________________________

Housing Assistance________________________________

Other Income______________________________________ Other Expenses_________________________

Gross Total Income________________________________ Total Expenses_________________________

5. I hereby certify that the information contained in my application is correct.

Applicant Signature____________________________________________Date_________________________

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