Ironwood Teen Scholarship Form

 

REQUEST FORM FOR FINANCIAL ASSISTANCE FOR IRONWOOD SPRINGS TEEN CAMP

FROM KWIK TRIP SCRIP TEEN SCHOLARSHIP FUND

 

Please fill out all information below

*All requests and grants are confidential and known only to grant committee and pastor.

*Priority will be given to: Financial need, households sending other siblings to Ironwood,  Fusion teens and households participating in the Cedar Creek Kwik Trip gift card purchase program.

*Deadline for submitting request is   May 12 .  

Please turn in to Pastor Aaron.

*Any requests submitted past the deadline will be considered only as there are still funds available

 *Funds are limited but there is no limit on amount of request

 

PARENT(S) NAMES(S)_______________________________________________________

 

TEEN NAME _____________________________________

 

NUMBER OF SIBLINGS ALSO ATTENDING IRONWOOD CAMP _________

 

___ SINGLE INCOME HOUSE HOLD or    ____ DOUBLE INCOME HOUSEHOLD

 

FULL ADDRESS________________________________________________________________

 

PHONE NUMBER ____________________________________________________________

 

CAMP SESSION AND DATES PLANNING ON ATTENDING______________________________

 

REQUESTED AMOUNT OF ASSISTANCE _________________

 

 

 

BRIEFLY EXPLAIN WHY YOU ARE REQUESTING HELP FROM THE CEDAR CREEK KWIK TRIP SCHOLARSHIP FUND

 

 

 

 

 

 

 

 

Questions? Please contact Pastor Aaron: 507-951-6594

 

$___________ amount this household spent on Kwik Trip cards the past year

(To be filled out by church) 

Sunday
Sunday morning service 10:00 AM

Cedar Creek Church
30 East Main Street
PO Box 224
Hayfield, MN 55940
507-477-2255
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