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
TEEN NAME _____________________________________
NUMBER OF SIBLINGS ALSO ATTENDING IRONWOOD CAMP _________
___ SINGLE INCOME HOUSE HOLD or ____ DOUBLE INCOME HOUSEHOLD
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 morning service||10:00 AM|
Cedar Creek Church
30 East Main Street
PO Box 224
Hayfield, MN 55940