Template Entry

Scholarship Request Form

Questions? Email Kristin Sauerbrei at kristin.sauerbrei@naz.org

Students First Name

Students Last Name

Students Email

Students Mobile Phone

Students School

Students Grade

Home Church

Why are you interested in being a part of Riverside Camp?

Have you received scholarship assistance from us in the past?

Yes No

If yes, which trip?

If yes, amount received?

Please describe the circumstances surrounding your need for financial assistance:

Will a 25% scholarship meet your financial needs?

Yes No

If not, from a financial standpoint, how much do you think you can contribute for Camp?

What is the total cost of the camp experience that you are desiring to attend?

Any other Information that would be helpful for us to know?

Parent/Guardian Name

Parent/Guardian Email

Parent/Guardian Mobile Phone

Submit Application

CHAOS is made possible by volunteers who help us each week. We'd love for you to join our team!