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Duval County 4-H: Summer Camping Scholarship Application
These funds are intended to provide an opportunity for youth who otherwise would be financially unable to
participate in 4-H Camp Cherry Lake. Submit the youth 4-H Camp scholarship application to the Duval
County Extension Office, 4-H Foundation at 1010 N. McDuff Ave by June 1. 4-H Camp registration must also
be submitted, and a deposit must be paid. Applications completed and submitted on time will be given priority
for these scholarships. [Application follows.]
HOW TO APPLY: The following guidelines have been established for applying for financial assistance to attend
residential camp at Camp Cherry Lake with Duval County 4-H.
1. Any youth who are potential participants (ages 8-18 as of September 1 in the previous year) in Duval County 4-H
Extension youth programs, or programs recognized by the State 4-H Youth Development office are eligible. Young
people do not have to be a 4-H club member to receive financial assistance; however to be considered for consecutive
years, youth must be 4-H members.
2. Participants will bear some portion of the activity cost. At minimum, families must pay a $25 registration deposit. It has
been our experience that those who pay a portion of the cost to participate in an event do so with a more positive
attitude.
3.
The Duval County 4-H Foundation, and 4-H Camping program have a limited amount of funding available for
financial assistance each year. These funds will be distributed among as many different individuals as possible.
Therefore, individuals requesting assistance for a second year in a row will not receive as high of a priority as someone
who has not previously received assistance.
4. 4-H Camp Financial Assistance Application for Youth Form is due by June 1 to the Duval County Extension Office.
Applications that are complete and received on time will be reviewed first, and given priority. If funding is still available
afterwards the committee will review late applications, and incomplete applications will not be considered.
5. Use a separate application for EACH applicant. Families, please attach applications together if you are submitting
more than one. The minimum family cost for 2 or more children will be a $50 deposit per family.
6.
The application requires two statements. One from the camper telling us why they want to attend 4-H camp. (This
should be written by the camper, or dictated to an adult if assistance is necessary.) The second from a parent/guardian,
4-H leader, or Extension staff member explaining the financial circumstance of the family and any other relevant
information. No funding will be provided without these statements. The statements can be written in the boxes on the
attached application form, or if there is not adequate space, they may be attached on a single, separate page (one side
only). Letters may be handwritten or typed for the parent/guardian. Youth are encouraged to hand write their portion.
7.
Important: This application form is for financial aid only. Receiving financial assistance does not register your youth
for camp. Camp registration is available on our website: http://duval.ifas.ufl.edu/4-H_camps.shtml and will lead you to
the online system.
8. Your camp deposit and registration form must be sent directly to the Duval County Extension Office, or it may be
delivered or emailed according to the instructions.
9. Award announcements will be made no later than June 15 to each family, which will allow campers 2 weeks to prepare
for camp, and 1 week for them to submit all forms and attend orientation night. Financial assistance from the Duval
County 4-H Foundation will be deducted from your camp registration balance, and will be kept privately.
The University shall actively promote equal opportunity policies and practices conforming to laws against discrimination. The University is committed
to non-discrimination with respect to race, creed, color, religion, age, disability, sex, sexual orientation, gender identity and expression, marital status,
national origin, political opinions or affiliations, genetic information and veteran status as protected under the Vietnam Era Veterans' Readjustment
Assistance Act.
Duval County 4-H: Camp Financial Assistance Application for Youth
Application due to your County Extension Office by June 1
ONE YOUTH PER APPLICATION, Families please attach all applications together.
NOTE: This is an application for 4-H camp financial aid only. 4-H camp registrations, and the deposit must be submitted
in order to be considered for the scholarship. For application procedures see "4-H Camp Financial Assistance Application
for Youth Instructions".
Please submit applications by mailing or delivering them to: The Duval County Extension Office, Attn: 4-H
1010 N. McDuff Ave, Jacksonville, Fl 32254
You may also submit the application via scanned email to: jaltum@ufl.edu
1. Camper Information
Name:__________________________________________________________________________
Age (as of 9/1/14): _______
Gender: ________________
Mailing address with City/State/Zip: _________________________________________________________
_________________________________________________________
County of residence: __________________________
Name of Parent(s)/Guardian(s): _________________________________________________________
Phone: ________________________________________
Email: _________________________________________
Why I want to attend 4-H camp (to be completed by camper or dictated to parent/guardian):
2. Camp cost and Funding Request
Camp Session Cost : $215 before May 1, after May 1 $230
The amount I will be able to pay (including deposit $25/ youth, or $50 per family minimum):
Amount requested from the Duval County 4-H Foundation = $
Have you ever received 4-H camp financial assistance from the Duval County 4-H Foundation?
Is this your first 4-H camp experience?
3. Financial need:
To be completed by parent/guardian, Extension staff, or volunteer leader. Please provide information and statement
regarding the financial need of this individual to assist the selection committee in making allocations.
Please check all that apply: NEW 4-H member___ single parent ___ ADC food stamps__
free or reduced school lunches___ loss of job(s)__ health condition(s)___ bankruptcy___ other ___
Please attach an explanation of circumstances, and on why you believe 4-H camp will be of benefit to this child.
Signatures and Explanation of Need on Back
Explanation of circumstances, and on why you believe 4-H camp will be of benefit to this child:
4. Required Signatures:
Signature of Applicant: _______________________________________________
Signature of Parent/Guardian: ___________________________________________
Signature of County Extension Staff Member: _______________________________
Date
Date
Date:
Please remember to submit this application by the priority deadline, June 1.
All applicants will receive notification of the scholarship dispersal by June 15.
Upon notification, each camper must submit all camp paperwork by June 23.
Campers are also encouraged to attend the Camp orientation on June 23 at 6pm at the Duval County Extension Office.
1010 N. McDuff Ave.