2024 MVNU Academic Summer Camp - Scholarship Application

Participant Information:

Participant First Name:

Participant Middle Name:

Participant Last Name:

Participant's Preferred/Nickname:

Birthdate:

Sex

Female

Male

Participant's Phone Number:

Participant's Email Address

Mailing Address

Country

Street

City

Region

Postal Code

Permanent Address

Same as Mailing Address

Country

Street

City

Region

Postal Code

T-shirt size

High School Name

High School Graduation Year

Do you have a Specific roommate request?
If so, please enter their First and Last name:

What church do you attend if any?

Parent/Guardian's First Name:

Parent/Guardian's Last Name:

Relationship to Camper

Parent/Guardian's Phone Number:

Parent/Guardian's Email:

Optional: Race/Ethnicity

Are you Hispanic or Latino of any race (this includes Spanish and other Spanish origins)?

Yes

No

Race (Click all that apply)

Camp Information

What is your first choice for a summer camp?

What is your second choice for a summer camp?

What is your third choice for a summer camp?

* Students granted a scholarship for Nursing camp will be enrolled to earn an official American Heart Associations certification in Basic Life Saving CPR. This is an additional value of $30.

Do you have a Waiver Code?

Yes

No

Check the one that applies to you:

A student from Knox County, OH with financial need

None of the above

If you have a Waiver Code enter it below:

Sorry, at this time no scholarship support is available to you.

If you would like to be contacted in the case that additional funding opportunities become available, please submit your information now. If you have any further questions, contact the Academic Summer Camp at MVNU.SummerCamps@mvnu.edu.

In no more than 250 words, explain why you are interested in attending MVNU's Academic Summer Camps.

References

Reference 1: High School Counselor

School Counselor First Name

School Counselor Last Name

School Counselor Email

School Counselor Phone

Reference 2: Pastor, teacher, mentor, employer, etc.

Reference 2 First Name

Reference 2 Last Name

Reference 2 Email

Reference 2 Phone

Certification Statement

By submitting this application:

I am affirming that the information above is accurate and my own work.
I am affirming that my family has financial need as indicated in the table found below:

Income Eligibility Guidelines
Household Size	Annual	Monthly	Twice-Monthly	Bi-Weekly	Weekly
1	$23,828	$1,986	$939	$917	$459
2	$32,227	$2,686	$1343	$1,240	$620
3	$40,626	$3,386	$1,693	$1,563	$782
4	$49,025	$4,086	$2,043	$1,886	$943
5	$57,424	$4,786	$2,393	$2.209	$1,105
6	$65,823	$5,486	$2,743	$2,532	$1,266
7	$74,222	$6,186	$3,093	$2,855	$1,428
8	$82,621	$6,886	$3,443	$3,178	$1,589
Each additional family member add	$8,339	$700	$350	$324	$162

I agree that if I am awarded a scholarship, I will respond in the allotted time or forfeit my scholarship.

Signature

I affirm the statement above is true

Electronic Signature of Participant

Date

Electronic Signature of Legal Guardian

Date

2024 MVNU Academic Summer Camp - Scholarship Application

Income Eligibility Guidelines

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