PERMIAN BASIN FCA

CAMP SCHOLARSHIP REQUEST

Camp Scholarship Request

Please complete the form to request your camp scholarship. Once submitted, our staff will follow up with you to share a "coupon code" that you can use to register for camp.

*This request form is for PERMIAN BASIN STUDENTS ONLY. All FCA funds and scholarships are raised locally and distributed to Permian Basin area students. If you are from another area, reach out to your area FCA staff or ask us and we'll help connect them to you for further assistance.

CAMP SCHOLARSHIPS FOR FCA SUMMER CAMP @ HSU NOW OPEN.

Dustin Pearce

Permian Basin Area Director

dpearce@fca.org

Grace Rich Villanueva

Permian Basin Admin. Assistant

grich@fca.org

Jocelyn Kennedy

Camp Registrar

jkennedy@fca.org | 806-543-4103

Camp scholarship form

Camper Name (First, Last)

Camper Gender

Camper Birthdate

Camper Grade Next Fall

Camper School

Parent / Guardian Name (First, Last)

Address

City

State

Zip Code

Phone Number

What FCA Camp are you applying for a scholarship to attend?

What scholarship amount are you requesting?

Have you attended FCA Camp in the past?

Have you received FCA scholarship for camp before?

Does your school have a FCA Huddle? If yes, are you involved?

Household combined annual income?

How many children/siblings (ages) live in your home?

Any questions or comments?

PERMIAN BASIN FCA

﻿CAMP SCHOLARSHIP REQUEST

Camp scholarship form

Contact Info

CAMP SCHOLARSHIP REQUEST